TY  - JOUR
A1  - Hofmann, Wolf-Peter
A1  - Buggisch, Peter
A1  - Schubert, Lisa
A1  - Dikopoulos, Nektarios
A1  - Schwenzer, Jeannette
A1  - Muche, Marion
A1  - Felten, Gisela
A1  - Heyne, Renate
A1  - Ingiliz, Patrick Philipp
A1  - Schmidt, Anna
A1  - Stein, Kerstin
A1  - Wedemeyer, Heiner
A1  - Berg, Thomas
A1  - Wiegand, Johannes
A1  - Lammert, Frank
A1  - Zeuzem, Stefan
A1  - Schattenberg, Jörn Markus
T1  - The Fatty Liver Assessment in Germany (FLAG) cohort study identifies large heterogeneity in NAFLD care
T2  - JHEP Reports
N2  - 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.
Y1  - 2020
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/55578
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-555781
SN  - 2589-5559
VL  - 2
IS  - 100168
PB  - Elsevier
CY  - Amsterdam
ER  -