Validation of AGA clinical care pathway and AASLD practice guidance for nonalcoholic fatty liver disease in a prospective cohort of patients with type 2 diabetes Article Swipe
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· 2023
· Open Access
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· DOI: https://doi.org/10.1097/hep.0000000000000635
Background and Aims: Recently, the American Gastroenterological Association and the American Association for the Study of Liver Diseases developed clinical pathways to evaluate populations at high risk for NAFLD. We assessed the diagnostic performance of the new guidance in a well-phenotyped cohort of patients with Type 2 diabetes mellitus (T2DM). Approach and Results: This prospective study enrolled patients age ≥50 years with T2DM. Participants underwent a standardized clinical research visit with MRI and ultrasound-based assessment of liver fat and stiffness and Enhanced Liver Fibrosis (ELF) testing. Of 417 participants (36% men) with T2DM with FIB-4 and MRE data, the prevalence of NAFLD was 64% and 12% had advanced fibrosis (MRE≥3.63 kPa). Applying the American Gastroenterological Association pathway of FIB-4 and vibration-controlled transient elastography, the false negative rate was 3.3% and 18% would qualify for specialty referral. Applying the FIB-4 + ELF American Association for the Study of Liver Diseases pathway, the false negative rate was 4.5%, but 50% would qualify for specialty referral. Applying higher ELF cut points improved the pathway, yielding a similar false negative rate of 4.9% but decreased specialty referral to 27%. Conclusion: Validation of the American Gastroenterological Association clinical pathway in a prospectively recruited cohort with T2DM revealed a low false negative rate and avoided specialty referral in a large percentage of patients. The American Association for the Study of Liver Diseases pathway with FIB-4 + ELF resulted in a high rate of specialty referral, which improved with the utilization of higher ELF cut points and may serve as an alternative for primary care and endocrinology clinics without access to vibration-controlled transient elastography.
Related Topics
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1097/hep.0000000000000635
- OA Status
- green
- Cited By
- 19
- References
- 35
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4387823662
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4387823662Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1097/hep.0000000000000635Digital Object Identifier
- Title
-
Validation of AGA clinical care pathway and AASLD practice guidance for nonalcoholic fatty liver disease in a prospective cohort of patients with type 2 diabetesWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2023Year of publication
- Publication date
-
2023-10-20Full publication date if available
- Authors
-
Veeral Ajmera, Kaleb Tesfai, Erick Sandoval, Scarlett Lopez, Vanessa Cervantes, Egbert Madamba, Ricki Bettencourt, Pinelopi Manousou, Lisa Richards, Rohit LoombaList of authors in order
- Landing page
-
https://doi.org/10.1097/hep.0000000000000635Publisher landing page
- Open access
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YesWhether a free full text is available
- OA status
-
greenOpen access status per OpenAlex
- OA URL
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https://www.ncbi.nlm.nih.gov/pmc/articles/11023802Direct OA link when available
- Concepts
-
Nonalcoholic fatty liver disease, Medicine, Type 2 diabetes, Internal medicine, Prospective cohort study, Cohort, Clinical Practice, Diabetes mellitus, Cohort study, Fatty liver, Disease, Gastroenterology, Endocrinology, Family medicineTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
19Total citation count in OpenAlex
- Citations by year (recent)
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2025: 10, 2024: 8, 2023: 1Per-year citation counts (last 5 years)
- References (count)
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35Number of works referenced by this work
- Related works (count)
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.access | 262 |
| abstract_inverted_index.cohort | 41, 198 |
| abstract_inverted_index.higher | 164, 245 |
| abstract_inverted_index.points | 167, 248 |
| abstract_inverted_index.(T2DM). | 49 |
| abstract_inverted_index.avoided | 208 |
| abstract_inverted_index.clinics | 260 |
| abstract_inverted_index.pathway | 116, 193, 226 |
| abstract_inverted_index.primary | 256 |
| abstract_inverted_index.qualify | 132, 159 |
| abstract_inverted_index.similar | 173 |
| abstract_inverted_index.without | 261 |
| abstract_inverted_index.American | 5, 10, 113, 141, 189, 218 |
| abstract_inverted_index.Applying | 111, 136, 163 |
| abstract_inverted_index.Approach | 50 |
| abstract_inverted_index.Diseases | 17, 148, 225 |
| abstract_inverted_index.Enhanced | 81 |
| abstract_inverted_index.Fibrosis | 83 |
| abstract_inverted_index.Results: | 52 |
| abstract_inverted_index.advanced | 107 |
| abstract_inverted_index.assessed | 30 |
| abstract_inverted_index.clinical | 19, 67, 192 |
| abstract_inverted_index.diabetes | 47 |
| abstract_inverted_index.enrolled | 56 |
| abstract_inverted_index.evaluate | 22 |
| abstract_inverted_index.fibrosis | 108 |
| abstract_inverted_index.guidance | 37 |
| abstract_inverted_index.improved | 168, 240 |
| abstract_inverted_index.mellitus | 48 |
| abstract_inverted_index.negative | 125, 152, 175, 205 |
| abstract_inverted_index.pathway, | 149, 170 |
| abstract_inverted_index.pathways | 20 |
| abstract_inverted_index.patients | 43, 57 |
| abstract_inverted_index.referral | 182, 210 |
| abstract_inverted_index.research | 68 |
| abstract_inverted_index.resulted | 231 |
| abstract_inverted_index.revealed | 201 |
| abstract_inverted_index.testing. | 85 |
| abstract_inverted_index.yielding | 171 |
| abstract_inverted_index.Recently, | 3 |
| abstract_inverted_index.decreased | 180 |
| abstract_inverted_index.developed | 18 |
| abstract_inverted_index.patients. | 216 |
| abstract_inverted_index.recruited | 197 |
| abstract_inverted_index.referral, | 238 |
| abstract_inverted_index.referral. | 135, 162 |
| abstract_inverted_index.specialty | 134, 161, 181, 209, 237 |
| abstract_inverted_index.stiffness | 79 |
| abstract_inverted_index.transient | 121, 265 |
| abstract_inverted_index.underwent | 64 |
| abstract_inverted_index.Background | 0 |
| abstract_inverted_index.Validation | 186 |
| abstract_inverted_index.assessment | 74 |
| abstract_inverted_index.diagnostic | 32 |
| abstract_inverted_index.percentage | 214 |
| abstract_inverted_index.prevalence | 99 |
| abstract_inverted_index.(MRE≥3.63 | 109 |
| abstract_inverted_index.Association | 7, 11, 115, 142, 191, 219 |
| abstract_inverted_index.Conclusion: | 185 |
| abstract_inverted_index.alternative | 254 |
| abstract_inverted_index.performance | 33 |
| abstract_inverted_index.populations | 23 |
| abstract_inverted_index.prospective | 54 |
| abstract_inverted_index.utilization | 243 |
| abstract_inverted_index.Participants | 63 |
| abstract_inverted_index.participants | 88 |
| abstract_inverted_index.standardized | 66 |
| abstract_inverted_index.elastography, | 122 |
| abstract_inverted_index.elastography. | 266 |
| abstract_inverted_index.endocrinology | 259 |
| abstract_inverted_index.prospectively | 196 |
| abstract_inverted_index.well-phenotyped | 40 |
| abstract_inverted_index.ultrasound-based | 73 |
| abstract_inverted_index.Gastroenterological | 6, 114, 190 |
| abstract_inverted_index.vibration-controlled | 120, 264 |
| cited_by_percentile_year.max | 99 |
| cited_by_percentile_year.min | 89 |
| corresponding_author_ids | https://openalex.org/A5052059601 |
| countries_distinct_count | 2 |
| institutions_distinct_count | 10 |
| corresponding_institution_ids | https://openalex.org/I36258959 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.6600000262260437 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.95977639 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | True |