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Background & aims: The impact of marijuana on nonalcoholic fatty liver disease (NAFLD) is largely unknown. We studied the association between marijuana and NAFLD utilizing cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) from 2005–2014 and NHANES III (1988–1994). Methods: Suspected NAFLD was diagnosed if serum alanine aminotransferase (ALT) was > 30 IU/L for men and > 19 IU/L for women in the absence of other liver diseases (NHANES 2005–2014). In NHANES III cohort, NAFLD was defined based on ultrasonography. Results: Of the 14,080 (NHANES 2005–2014) and 8,286 (NHANES III) participants, prevalence of suspected NAFLD and ultrasonographically-diagnosed NAFLD were inversely associated with marijuana use (p < 0.001). Compared to marijuana-naïve participants, marijuana users were less likely to have suspected NAFLD (odds ratio [OR]: 0.90, 95% confidence interval [CI]: 0.82–0.99 for past user; OR: 0.68, 95% CI: 0.58–0.80 for current user) and ultrasonographically-diagnosed NAFLD (OR: 0.75, 95% CI: 0.57–0.98 for current user) in the age, gender, ethnicity-adjusted model. On multivariate analysis, the ORs for suspected NAFLD comparing current light or heavy users to non-users were 0.76 (95% CI 0.58–0.98) and 0.70 (95% CI 0.56–0.89), respectively (P for trend = 0.001) with similar trends in ultrasonographically-diagnosed NAFLD (OR: 0.77, 95% CI: 0.59–1.00 for current user; OR: 0.71, 95% CI: 0.51–0.97 for current light user). In insulin resistance-adjusted model, marijuana use remained an independent predictor of lower risk of suspected NAFLD. Conclusions: In this nationally representative sample, active marijuana use provided a protective effect against NAFLD independent of known metabolic risk factors. The pathophysiology is unclear and warrants further investigation. [ABSTRACT FROM AUTHOR]

The accurate prognostic stratification of alcoholic hepatitis (AH) is essential for individualized therapeutic decisions. The aim of this study was to develop a new prognostic model to predict liver-related mortality in Asian AH patients. We conducted a hospital-based, retrospective cohort study using 308 patients with AH between 1999 and 2011 (a derivation cohort) and 106 patients with AH between 2005 and 2012 (a validation cohort). The Cox proportional hazards model was constructed to select significant predictors of liver-related death from the derivation cohort. A new prognostic model was internally validated using a bootstrap sampling method. The discriminative performance of this new model was compared with those of other prognostic models using a concordance index in the validation cohort. Bilirubin, prothrombin time, creatinine, potassium at admission, and a spontaneous change in bilirubin levels from day 0 to day 7 (SCBL) were incorporated into a model for AH to grade the severity in an Asian patient cohort (MAGIC). For risk stratification, four risk groups were identified with cutoff scores of 29, 37, and 46 based on the different survival probabilities (P<0.001). In addition, MAGIC showed better discriminative performance for liver-related mortality than any other scoring system in the validation cohort. MAGIC can accurately predict liver-related mortality in Asian patients hospitalized for AH. Therefore, SCBL may help us decide whether patients with AH urgently require corticosteroid treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVES:Non-alcoholic fatty liver disease (NAFLD) is known to be related to factors that predict the development of coronary heart disease (CHD), such as dyslipidemia, central obesity, and metabolic syndrome (MS). The aim of this study was to determine whether individuals with NAFLD have an elevated risk of CHD, as estimated using the Framingham risk score (FRS).METHODS:A total of 21,130 individuals who underwent a voluntary general health examination were recruited. NAFLD was diagnosed among these individuals on the basis of typical sonographic findings and a level of alcohol consumption of <20 g/day. Of the 21,130 individuals, 3,780 were excluded because they had known causes of liver disease (1,690 were alcoholics, 975 had hepatitis B virus, 242 had hepatitis C virus, 91 had other hepatitis history, and 593 were taking medication known to produce fatty liver) or a history of heart disease (189).RESULTS:NAFLD was diagnosed in 5,769 of the 17,350 individuals (33.3%). The 11,581 normal individuals constituted the control group. The 5,769 individuals with NAFLD were split into two groups on the basis of ultrasonographic findings, that is, into a mild NAFLD group (n=3,278) and a moderate–severe NAFLD group (n=2,491). Individuals with NAFLD had an elevated risk of CHD, as estimated using FRS. Multivariable regression analysis, adjusted for confounding factors, showed a strong association between a higher FRS and NAFLD.CONCLUSIONS:Individuals with ultrasonographically detected NAFLD have an elevated 10-year risk of developing CHD as estimated using FRS. Furthermore, NAFLD was found to be independently related to the risk of developing CHD, regardless of classical risk factors and other components of MS.Am J Gastroenterol 2009; 104:1953–1960; doi:10.1038/ajg.2009.238; published online 2 June 2009 [ABSTRACT FROM AUTHOR]