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Abstract Details
The Fatty Liver Assessment in Germany (FLAG) cohort study identifies large heterogeneity in NAFLD care
JHEP Rep. 2020 Aug 4;2(6):100168. doi: 10.1016/j.jhepr.2020.100168. eCollection 2020 Dec.
Wolf Peter Hofmann12, Peter Buggisch23, Lisa Schubert14, Nektarios Dikopoulos5, Jeannette Schwenzer6, Marion Muche4, Gisela Felten7, Renate Heyne8, Patrick Ingiliz9, Anna Schmidt10, Kerstin Stein11, Heiner Wedemeyer12, Thomas Berg13, Johannes Wiegand13, Frank Lammert14, Stefan Zeuzem15, Jörn M Schattenberg1617
Author information
1Gastroenterologie am Bayerischen Platz, Berlin, Germany.
2Association of Gastroenterologists in Private Practice (Berufsverband Niedergelassener Gastroenterologen Deutschlands), Ulm, Germany.
3IFI Institut für interdisziplinäre Medizin, Hamburg, Germany.
4Medical Department (Gastroenterology, Infectiology, Rhumatology) Charité Campus Benjamin Franklin, Berlin, Germany.
9Zentrum für Infektiologie Prenzlauer Berg, Berlin, Germany.
10Magen-Darm-Zentrum Wiener Platz, Cologne, Germany.
11Praxis für Infektiologie und Hepatologie Magdeburg, Magdeburg, Germany.
12Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
13Division of Hepatology, Department of Medicine II, Leipzig University Hospital, Leipzig, Germany.
14Department of Medicine II, Saarland University Hospital, Homburg, Germany.
15Department of Internal Medicine, Goethe University Hospital Frankfurt, Frankfurt, Germany.
16I. Department of Medicine, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
17Metabolic Liver Research Program, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
Abstract
Background & aims: NAFLD is a growing health concern. The aim of the Fatty Liver Assessment in Germany (FLAG) study was to assess disease burden and provide data on the standard of care from secondary care.
Methods: The FLAG study is an observational real-world study in patients with NAFLD enrolled at 13 centres across Germany. Severity of disease was assessed by non-invasive surrogate scores and data recorded at baseline and 12 months.
Results: In this study, 507 patients (mean age 53 years; 47% women) were enrolled. According to fibrosis-4 index, 64%, 26%, and 10% of the patients had no significant fibrosis, indeterminate stage, and advanced fibrosis, respectively. Patients with advanced fibrosis were older, had higher waist circumferences, and higher aspartate aminotransferase and gamma-glutamyltransferase as well as ferritin levels. The prevalence of obesity, arterial hypertension, and type 2 diabetes increased with fibrosis stages. Standard of care included physical exercise >2 times per week in 17% (no significant fibrosis), 19% (indeterminate), and 6% (advanced fibrosis) of patients. Medication with either vitamin E, silymarin, or ursodeoxycholic acid was reported in 5%. Approximately 25% of the patients received nutritional counselling. According to the FibroScan-AST score, 17% of patients presented with progressive non-alcoholic steatohepatitis (n = 107). On follow-up at year 1 (n = 117), weight loss occurred in 47% of patients, of whom 17% lost more than 5% of body weight. In the weight loss group, alanine aminotransferase activities were reduced by 20%.
Conclusions: This is the first report on NAFLD from a secondary-care real-world cohort in Germany. Every 10th patient presented with advanced fibrosis at baseline. Management consisted of best supportive care and lifestyle recommendations. The data highlight the urgent need for systematic health agenda in NAFLD patients.
Lay summary: FLAG is a real-world cohort study that examined the liver disease burden in secondary and tertiary care. Herein, 10% of patients referred to secondary care for NAFLD exhibited advanced liver disease, whilst 64% had no significant liver scarring. These findings underline the urgent need to define patient referral pathways for suspected liver disease.