Department of Gastroenterology and Hepatology, Imperial College London, London, UK.
Department of Medicine, Brighton and Sussex Medical School, Brighton, UK.
BMJ Open Gastroenterol. 2020 Nov;7(1). doi: 10.1136/bmjgast-2020-000524.
Chronic liver disease (CLD) is a largely preventable condition with increasing burden on National Health Service resources. We aimed to determine the prevalence of behavioural risk factors for CLD and their association with liver stiffness and socioeconomic status in the UK.
In this cross-sectional study, adults aged ≥18 years were invited to complete a liver health screener and have a liver stiffness measurement (LSM) by transient elastography (TA) to screen for alcohol intake, obesity and viral hepatitis risk across different areas in the UK. Index of Multiple Deprivation (IMD) scores were used as a measure of socioeconomic status. We performed binary logistic regression, adjusting for age, gender, alcohol consumption, body mass index, diet and viral hepatitis risk to determine the factors associated with LSM and IMD.
We analysed the data from 2150 individuals across 25 UK areas. Of those, 24.1% had high-risk alcohol consumption, 29.6% had high-risk diets, 24.7% were obese and 32.7% had risk factors for viral hepatitis. LSMs were available for 1043 participants, of which 16.2% were ≥7 kPa. Independent predictors of an LSM≥7 kPa were an age≥40 years (OR, 1.986; 95% CI, 1.280 to 3.081), male gender (OR, 1.599; 95% CI, 1.128 to 2.266), obesity (OR, 2.526; 95% CI, 1.383 to 4.614) and high-risk diet (OR, 2.197; 95% CI, 1.000 to 4.826). Five-unit increases in IMD score were an independent predictor of obesity (OR, 1.110; 95% CI, 1.028 to 1.200), but not high-risk alcohol consumption (p=0.88) or viral hepatitis risk (p=0.05).
We identified a high prevalence of risk factors for CLD, most of which are addressable through raising public awareness to inculcate healthy habits. More studies are needed to assess longitudinal outcomes of liver screening using TA, accounting for societal factors and comorbidities, to help inform resource allocation and policy-making in the future.
慢性肝病（CLD）是一种可以通过预防来控制的疾病，但它给国民医疗服务体系资源带来的负担日益加重。本研究旨在确定英国成年人中 CLD 的行为危险因素流行情况，及其与肝硬度和社会经济地位的相关性。
在这项横断面研究中，邀请年龄≥18 岁的成年人填写一份肝脏健康筛查问卷，并通过瞬时弹性成像（TA）进行肝硬度测量（LSM），以筛查英国不同地区的饮酒、肥胖和病毒性肝炎风险。使用多因素剥夺指数（IMD）评分作为社会经济地位的衡量标准。我们进行了二元逻辑回归分析，调整了年龄、性别、饮酒量、体重指数、饮食和病毒性肝炎风险等因素，以确定与 LSM 和 IMD 相关的因素。
我们分析了来自英国 25 个地区的 2150 名成年人的数据。其中，24.1%有高风险饮酒，29.6%有高风险饮食，24.7%肥胖，32.7%有病毒性肝炎风险因素。1043 名参与者提供了 LSM 数据，其中 16.2%≥7kPa。LSM≥7kPa 的独立预测因素包括年龄≥40 岁（比值比，1.986；95%置信区间，1.280 至 3.081）、男性（比值比，1.599；95%置信区间，1.128 至 2.266）、肥胖（比值比，2.526；95%置信区间，1.383 至 4.614）和高风险饮食（比值比，2.197；95%置信区间，1.000 至 4.826）。IMD 评分每增加 5 分是肥胖的独立预测因素（比值比，1.110；95%置信区间，1.028 至 1.200），但不是高风险饮酒（p=0.88）或病毒性肝炎风险（p=0.05）的独立预测因素。
我们发现 CLD 的危险因素发病率很高，其中大多数可以通过提高公众意识来养成健康习惯来解决。需要进一步研究使用 TA 进行肝脏筛查的纵向结果，考虑社会因素和合并症，以帮助为未来的资源分配和决策提供信息。
