Pub Date : 2026-01-01Epub Date: 2025-10-22DOI: 10.1016/j.aohep.2025.102142
Fátima Higuera-de-la-Tijera , Mario Reis Alvares-da-Silva , Graciela Elia Castro-Narro , Josué Barahona-Garrido , Enrique Carrera-Estupiñán , Jorge Garavito-Rentería , Héctor Adolfo Henríquez-Meléndez , Geovanny Hernández-Cely , Javier Mora-Lazo , Manuel Mendizabal , Gabriel Alejandro Mezzano-Puentes , Claudia P. Oliveira , Mário Guimarães Pessoa , Yanette Suárez-Quintero , José Antonio Velarde-Ruiz Velasco
Introduction and Objectives
Hepatic encephalopathy (HE) is a frequent and severe complication of cirrhosis, leading to rapid deterioration and increased mortality. Management varies across Latin America due to differences in disease awareness, diagnostic and therapeutic resources, and healthcare system structures. Standardized guidelines are crucial to improve outcomes.
Materials and Methods
To evaluate therapeutic strategies and develop region-specific recommendations, the Latin American Association for the Study of the Liver (ALEH) convened 15 experts from 9 countries. The consensus process, conducted in 9 phases using the Nominal Group Technique, included virtual meetings, platform-based collaboration, virtual voting, and two in-person sessions to finalize recommendations and the publication draft.
Results
The panel issued 23 recommendations covering the treatment of minimal and overt HE, as well as the prophylaxis and management of recurrent HE in cirrhotic patients.
Conclusions
This consensus provides updated, evidence-based guidelines emphasizing early diagnosis and effective management. It aims to optimize clinical outcomes, standardize treatment approaches, and enhance patient quality of life. Additionally, these recommendations seek to reduce morbidity, mortality, and hospital readmissions, addressing key challenges in the Latin American healthcare landscape.
{"title":"First Latin American consensus on the treatment and prophylaxis of hepatic encephalopathy","authors":"Fátima Higuera-de-la-Tijera , Mario Reis Alvares-da-Silva , Graciela Elia Castro-Narro , Josué Barahona-Garrido , Enrique Carrera-Estupiñán , Jorge Garavito-Rentería , Héctor Adolfo Henríquez-Meléndez , Geovanny Hernández-Cely , Javier Mora-Lazo , Manuel Mendizabal , Gabriel Alejandro Mezzano-Puentes , Claudia P. Oliveira , Mário Guimarães Pessoa , Yanette Suárez-Quintero , José Antonio Velarde-Ruiz Velasco","doi":"10.1016/j.aohep.2025.102142","DOIUrl":"10.1016/j.aohep.2025.102142","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Hepatic encephalopathy (HE) is a frequent and severe complication of cirrhosis, leading to rapid deterioration and increased mortality. Management varies across Latin America due to differences in disease awareness, diagnostic and therapeutic resources, and healthcare system structures. Standardized guidelines are crucial to improve outcomes.</div></div><div><h3>Materials and Methods</h3><div>To evaluate therapeutic strategies and develop region-specific recommendations, the Latin American Association for the Study of the Liver (ALEH) convened 15 experts from 9 countries. The consensus process, conducted in 9 phases using the Nominal Group Technique, included virtual meetings, platform-based collaboration, virtual voting, and two in-person sessions to finalize recommendations and the publication draft.</div></div><div><h3>Results</h3><div>The panel issued 23 recommendations covering the treatment of minimal and overt HE, as well as the prophylaxis and management of recurrent HE in cirrhotic patients.</div></div><div><h3>Conclusions</h3><div>This consensus provides updated, evidence-based guidelines emphasizing early diagnosis and effective management. It aims to optimize clinical outcomes, standardize treatment approaches, and enhance patient quality of life. Additionally, these recommendations seek to reduce morbidity, mortality, and hospital readmissions, addressing key challenges in the Latin American healthcare landscape.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102142"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-26DOI: 10.1016/j.aohep.2025.102150
Xiaohui Ye , Lingling He , Caihong Deng , Junru Yang , Ping Li , Hongshan Wei
Introduction and Objectives
Transient elastography (TE) has been widely used in clinical practice, but noninvasive prediction models based on TE for the assessment of liver fibrosis in primary biliary cholangitis (PBC) has not been reported before. The aim of this study is to develop the simple, accurate and noninvasive prediction models for the histologic staging of PBC based on TE.
Patients and Methods
Serologic testing, liver stiffness measurement (LSM), and histological assessment of 144 patients with PBC were collected retrospectively. In model group consisted of 96 patients, LSM and alkaline phosphatase (ALP) were identified as two independent predictors of PBC histological stage, which were used to establish two noninvasive models, Model A and Model B, to predict significant fibrosis (Ludwig stage ≥ 2) and advanced fibrosis (Ludwig stage ≥ 3), respectively. The performance of noninvasive models was then validated in the validation group (48 patients).
Results
The area under the ROC curve (AUROC) of Model A was 0.870 (95 % CI, 0.802-0.939) in the model group and 0.914 (95 % CI, 0.803-1.000) in the validation group. The AUROC of Model B was 0.948 (95 % CI, 0.888-0.998) in the model group and 0.906 (95 % CI, 0.824-0.987) in validation group. The above results were higher than the other five serologic markers.
Conclusions
The Model A and Model B were the efficient noninvasive models with high accuracy in predicting the histological stages of PBC.
{"title":"Noninvasive elastography-based assessment of liver fibrosis in primary biliary cholangitis","authors":"Xiaohui Ye , Lingling He , Caihong Deng , Junru Yang , Ping Li , Hongshan Wei","doi":"10.1016/j.aohep.2025.102150","DOIUrl":"10.1016/j.aohep.2025.102150","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Transient elastography (TE) has been widely used in clinical practice, but noninvasive prediction models based on TE for the assessment of liver fibrosis in primary biliary cholangitis (PBC) has not been reported before. The aim of this study is to develop the simple, accurate and noninvasive prediction models for the histologic staging of PBC based on TE.</div></div><div><h3>Patients and Methods</h3><div>Serologic testing, liver stiffness measurement (LSM), and histological assessment of 144 patients with PBC were collected retrospectively. In model group consisted of 96 patients, LSM and alkaline phosphatase (ALP) were identified as two independent predictors of PBC histological stage, which were used to establish two noninvasive models, Model A and Model B, to predict significant fibrosis (Ludwig stage ≥ 2) and advanced fibrosis (Ludwig stage ≥ 3), respectively. The performance of noninvasive models was then validated in the validation group (48 patients).</div></div><div><h3>Results</h3><div>The area under the ROC curve (AUROC) of Model A was 0.870 (95 % CI, 0.802-0.939) in the model group and 0.914 (95 % CI, 0.803-1.000) in the validation group. The AUROC of Model B was 0.948 (95 % CI, 0.888-0.998) in the model group and 0.906 (95 % CI, 0.824-0.987) in validation group. The above results were higher than the other five serologic markers.</div></div><div><h3>Conclusions</h3><div>The Model A and Model B were the efficient noninvasive models with high accuracy in predicting the histological stages of PBC.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102150"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145385889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-23DOI: 10.1016/j.aohep.2025.102163
Songhe Chen, Ye Chen, Kai Chen
{"title":"Beyond the epidemiological link: Targeting the gut-liver-kidney axis in hepatorenal disease","authors":"Songhe Chen, Ye Chen, Kai Chen","doi":"10.1016/j.aohep.2025.102163","DOIUrl":"10.1016/j.aohep.2025.102163","url":null,"abstract":"","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102163"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145601991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-02-12DOI: 10.1016/j.aohep.2026.102195
Min Zou, Shiye Yang, Jinkai Feng, Zengqiang Yang
{"title":"Re-evaluating serum IL-6 as a prognostic biomarker in HCC immunotherapy with atezolizumab plus bevacizumab: the critical role of baseline liver function and disease etiology","authors":"Min Zou, Shiye Yang, Jinkai Feng, Zengqiang Yang","doi":"10.1016/j.aohep.2026.102195","DOIUrl":"10.1016/j.aohep.2026.102195","url":null,"abstract":"","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102195"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146197292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-09-11DOI: 10.1016/j.aohep.2025.102115
Yuan He, Fan Zhang, Zixuan Zhang, Xianwen Zhang, Yifei Zhong
Introduction and Objectives
Chronic liver disease (CLD) and chronic kidney disease (CKD) are major public health concerns with significant morbidity and mortality worldwide. This study aimed to investigate the bidirectional association between CLD and CKD.
Patients and Methods
We conducted two longitudinal studies using data from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2020. Participants without baseline CKD were analyzed for the risk of CKD associated with CLD, and participants without baseline CLD were assessed for the risk of CLD associated with CKD. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (95% CIs).
Results
Of 3651 participants without baseline CKD, 575 developed CKD over a median follow-up of 9 years. The incidence of CKD was significantly higher in those with baseline CLD (37.25 vs. 18.08 per 1000 population). Baseline CLD was independently associated with an elevated risk of incident CKD (adjusted HR=1.93; 95% CI: 1.37–2.72; P < 0.001). Conversely, of 5530 participants without baseline CLD, 474 developed CLD. Participants with CKD had a significantly higher incidence of CLD (13.56 vs. 8.89 per 1000 population). Baseline CKD was independently associated with an increased risk of incident CLD (adjusted HR=1.68; 95% CI: 1.31–2.16; P < 0.001). The bidirectional associations remained robust in sensitivity analyses, and the association persisted across different subgroups.
Conclusions
This study provides evidence of a bidirectional relationship between CLD and CKD. These findings highlight the importance of integrated management strategies targeting both liver and kidney health.
简介和目标：慢性肝病（CLD）和慢性肾病（CKD）是世界范围内发病率和死亡率高的主要公共卫生问题。本研究旨在探讨CLD与CKD之间的双向关系。患者和方法：我们使用2011年至2020年中国健康与退休纵向研究（CHARLS）的数据进行了两项纵向研究。对无基线CKD的参与者进行CKD合并CLD的风险分析，对无基线CLD的参与者进行CLD合并CKD的风险评估。采用多变量Cox比例风险模型估计95%置信区间（95% ci）的风险比（hr）。结果：在3,651名无基线CKD的参与者中，575名在中位9年随访期间发展为CKD。CKD的发生率在基线CLD患者中明显更高（37.25 vs. 18.08 / 1000）。基线CLD与CKD发生风险升高独立相关（调整后HR=1.93; 95% CI: 1.37-2.72; P < 0.001）。相反，在没有基线CLD的5530名参与者中，474人发展为CLD。CKD患者的CLD发病率明显更高（每千人13.56 vs 8.89）。基线CKD与CLD发生风险增加独立相关（调整后HR=1.68; 95% CI: 1.31-2.16; P < 0.001）。在敏感性分析中，双向关联仍然是稳健的，并且这种关联在不同的亚组中持续存在。结论：本研究提供了CLD和CKD之间双向关系的证据。这些发现强调了针对肝脏和肾脏健康的综合管理策略的重要性。
{"title":"Bidirectional association between chronic liver disease and chronic kidney disease: a longitudinal study based on CHARLS 2011–2020 data","authors":"Yuan He, Fan Zhang, Zixuan Zhang, Xianwen Zhang, Yifei Zhong","doi":"10.1016/j.aohep.2025.102115","DOIUrl":"10.1016/j.aohep.2025.102115","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Chronic liver disease (CLD) and chronic kidney disease (CKD) are major public health concerns with significant morbidity and mortality worldwide. This study aimed to investigate the bidirectional association between CLD and CKD.</div></div><div><h3>Patients and Methods</h3><div>We conducted two longitudinal studies using data from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2020. Participants without baseline CKD were analyzed for the risk of CKD associated with CLD, and participants without baseline CLD were assessed for the risk of CLD associated with CKD. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (95% CIs).</div></div><div><h3>Results</h3><div>Of 3651 participants without baseline CKD, 575 developed CKD over a median follow-up of 9 years. The incidence of CKD was significantly higher in those with baseline CLD (37.25 vs. 18.08 per 1000 population). Baseline CLD was independently associated with an elevated risk of incident CKD (adjusted HR=1.93; 95% CI: 1.37–2.72; <em>P</em> < 0.001). Conversely, of 5530 participants without baseline CLD, 474 developed CLD. Participants with CKD had a significantly higher incidence of CLD (13.56 vs. 8.89 per 1000 population). Baseline CKD was independently associated with an increased risk of incident CLD (adjusted HR=1.68; 95% CI: 1.31–2.16; <em>P</em> < 0.001). The bidirectional associations remained robust in sensitivity analyses, and the association persisted across different subgroups.</div></div><div><h3>Conclusions</h3><div>This study provides evidence of a bidirectional relationship between CLD and CKD. These findings highlight the importance of integrated management strategies targeting both liver and kidney health.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102115"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-27DOI: 10.1016/j.aohep.2025.102149
Jorge Emilio Lira-Vera , Ángel Daniel Santana-Vargas , Gabriela Gutiérrez-Reyes , Oscar Morales-Gutiérrez , María de Fátima Higuera-de la Tijera , Diana Montemira-Orozco , Christian Hinojosa-Segura , Moisés Martínez-Castillo , Samantha Sánchez-Valle , María de los Ángeles Lemus-Peña , Daniel Montes de Oca-Ángeles , Abigail Hernández-Barragán , Marisela Hernández-Santillán , Yadira Lilian Béjar-Ramírez , José Luis Pérez-Hernández
Introduction and Objectives
The concept of Metabolic dysfunction and alcohol-associated steatotic liver disease (MetALD) is recent. Patients with MetALD may have a higher risk of developing steatosis, inflammation, fibrosis, and cirrhosis than Metabolic dysfunction-associated steatotic liver disease (MASLD) or Alcohol-associated liver disease (ALD) patients. This study aims to evaluate the presence and grade of steatosis and liver fibrosis in the open Mexican population to determine the frequency and stage of MASLD, ALD, and MetALD.
Patients and Methods
Subjects aged 18 years or older, of any gender, and with a body mass index (BMI) of 18.5 or higher, who were healthy and without pre-existing chronic diseases, liver disease, or cancer, and who donated blood to our center's blood bank between June 1, 2021, and March 31, 2022, were included. To estimate the grade of steatosis and liver fibrosis, vibration-controlled transient elastography (VCTE) was performed. The subjects were classified according to VCTE and alcohol consumption pattern into one of four groups: healthy subjects (HS), ALD, MASLD, and MetALD.
Results
The prevalence of MASLD, ALD, and MetALD was 45.3%, 17.5%, and 5.8%, respectively. Only 31.4% were considered as HS. However, the average BMI was out of range in all four groups, including HS. Grade 3 steatosis was observed in the MASLD and MetALD groups. Liver stiffness showed higher values in the MetALD group.
Conclusions
MetALD has the lowest prevalence compared to MASLD and ALD. However, MetALD has the highest grade of steatosis and liver fibrosis. High BMI and risky alcohol consumption were associated with the severity of liver disease.
{"title":"Assessment of metabolic dysfunction-associated steatotic liver disease, alcohol-associated liver disease, and metabolic dysfunction and alcohol-associated steatotic liver disease in open Mexican population","authors":"Jorge Emilio Lira-Vera , Ángel Daniel Santana-Vargas , Gabriela Gutiérrez-Reyes , Oscar Morales-Gutiérrez , María de Fátima Higuera-de la Tijera , Diana Montemira-Orozco , Christian Hinojosa-Segura , Moisés Martínez-Castillo , Samantha Sánchez-Valle , María de los Ángeles Lemus-Peña , Daniel Montes de Oca-Ángeles , Abigail Hernández-Barragán , Marisela Hernández-Santillán , Yadira Lilian Béjar-Ramírez , José Luis Pérez-Hernández","doi":"10.1016/j.aohep.2025.102149","DOIUrl":"10.1016/j.aohep.2025.102149","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>The concept of Metabolic dysfunction and alcohol-associated steatotic liver disease (MetALD) is recent. Patients with MetALD may have a higher risk of developing steatosis, inflammation, fibrosis, and cirrhosis than Metabolic dysfunction-associated steatotic liver disease (MASLD) or Alcohol-associated liver disease (ALD) patients. This study aims to evaluate the presence and grade of steatosis and liver fibrosis in the open Mexican population to determine the frequency and stage of MASLD, ALD, and MetALD.</div></div><div><h3>Patients and Methods</h3><div>Subjects aged 18 years or older, of any gender, and with a body mass index (BMI) of 18.5 or higher, who were healthy and without pre-existing chronic diseases, liver disease, or cancer, and who donated blood to our center's blood bank between June 1, 2021, and March 31, 2022, were included. To estimate the grade of steatosis and liver fibrosis, vibration-controlled transient elastography (VCTE) was performed. The subjects were classified according to VCTE and alcohol consumption pattern into one of four groups: healthy subjects (HS), ALD, MASLD, and MetALD.</div></div><div><h3>Results</h3><div>The prevalence of MASLD, ALD, and MetALD was 45.3%, 17.5%, and 5.8%, respectively. Only 31.4% were considered as HS. However, the average BMI was out of range in all four groups, including HS. Grade 3 steatosis was observed in the MASLD and MetALD groups. Liver stiffness showed higher values in the MetALD group.</div></div><div><h3>Conclusions</h3><div>MetALD has the lowest prevalence compared to MASLD and ALD. However, MetALD has the highest grade of steatosis and liver fibrosis. High BMI and risky alcohol consumption were associated with the severity of liver disease.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102149"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145399785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-11DOI: 10.1016/j.aohep.2025.102139
Tianhao Wu , Mingyi Du , Tiejun Zhang , Xingdong Chen , Zhenqiu Liu
Introduction and Objectives
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA), the most prevalent primary liver cancer subtypes, present significant global health challenges. We aimed to comprehensively compare their incidence rates, risk factors, and potential preventability.
Materials and Methods
We analyzed liver cancer histological subtypes from Cancer Incidence in Five Continents Volume XII and assessed 85 modifiable risk factors for HCC and iCCA using the UK Biobank data. We calculated population attributable fraction to assess the population preventability of the cancers.
Results
Incidence data from 49 countries revealed a moderate positive correlation between the incidences of HCC and iCCA (ρ=0.41, P=0.003), with the highest rates observed in the Republic of Korea (15.6 vs 3.3 per 100,000, respectively). The global variation of HCC incidence was more pronounced than iCCA. After applying a Bonferroni correction for p-value, we identified 42 modifiable risk factors for HCC (n=470) and eight for iCCA (n=508). The effects of nearly all risk factors were more pronounced for HCC than for iCCA. Up to 83.3 % of HCC cases could be attributed to modifiable risk factors, although the preventable fraction varied across subpopulations. By contrast, only 37.7 % of iCCA cases were attributable to such factors, and the preventable fraction remained consistent across subgroups.
Conclusions
Our findings reveal the distinct yet partly overlapping epidemiological characteristics of HCC and iCCA, emphasizing the urgent need to clarify risk factors for iCCA. However, these findings may not be globally applicable, as modifiable risk factors can differ across regions due to varying exposures.
简介和目的：肝细胞癌（HCC）和肝内胆管癌（iCCA）是最常见的原发性肝癌亚型，对全球健康构成重大挑战。我们的目的是全面比较它们的发病率、危险因素和潜在的可预防性。材料和方法：我们分析了五大洲癌症发病率第十二卷中的肝癌组织学亚型，并使用英国生物银行的数据评估了肝癌和iCCA的85个可改变的危险因素。我们计算了人群归因分数来评估癌症的人群可预防性。结果：来自49个国家的发病率数据显示，HCC发病率与iCCA之间存在中度正相关（ρ=0.41， P=0.003），其中韩国的发病率最高（分别为15.6 vs 3.3 / 100000）。HCC发病率的全球变化比iCCA更明显。应用Bonferroni校正p值后，我们确定了42个可改变的HCC危险因素（n=470）和8个可改变的iCCA危险因素（n=508）。几乎所有危险因素对HCC的影响都比对iCCA的影响更明显。高达83.3%的HCC病例可归因于可改变的危险因素，尽管可预防的部分在亚人群中有所不同。相比之下，只有37.7%的iCCA病例可归因于这些因素，可预防部分在亚组中保持一致。结论：我们的研究结果揭示了HCC和iCCA的不同但部分重叠的流行病学特征，强调了澄清iCCA危险因素的迫切需要。然而，这些发现可能并不适用于全球，因为可改变的风险因素可能因暴露程度不同而在不同地区有所不同。
{"title":"Comparisons of global incidence and risk factor profiles of hepatocellular carcinoma and intrahepatic cholangiocarcinoma","authors":"Tianhao Wu , Mingyi Du , Tiejun Zhang , Xingdong Chen , Zhenqiu Liu","doi":"10.1016/j.aohep.2025.102139","DOIUrl":"10.1016/j.aohep.2025.102139","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA), the most prevalent primary liver cancer subtypes, present significant global health challenges. We aimed to comprehensively compare their incidence rates, risk factors, and potential preventability.</div></div><div><h3>Materials and Methods</h3><div>We analyzed liver cancer histological subtypes from Cancer Incidence in Five Continents Volume XII and assessed 85 modifiable risk factors for HCC and iCCA using the UK Biobank data. We calculated population attributable fraction to assess the population preventability of the cancers.</div></div><div><h3>Results</h3><div>Incidence data from 49 countries revealed a moderate positive correlation between the incidences of HCC and iCCA (ρ=0.41, P=0.003), with the highest rates observed in the Republic of Korea (15.6 <em>vs</em> 3.3 per 100,000, respectively). The global variation of HCC incidence was more pronounced than iCCA. After applying a Bonferroni correction for p-value, we identified 42 modifiable risk factors for HCC (n=470) and eight for iCCA (n=508). The effects of nearly all risk factors were more pronounced for HCC than for iCCA. Up to 83.3 % of HCC cases could be attributed to modifiable risk factors, although the preventable fraction varied across subpopulations. By contrast, only 37.7 % of iCCA cases were attributable to such factors, and the preventable fraction remained consistent across subgroups.</div></div><div><h3>Conclusions</h3><div>Our findings reveal the distinct yet partly overlapping epidemiological characteristics of HCC and iCCA, emphasizing the urgent need to clarify risk factors for iCCA. However, these findings may not be globally applicable, as modifiable risk factors can differ across regions due to varying exposures.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102139"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-26DOI: 10.1016/j.aohep.2025.102168
Xiaoqin Xu , Jiang Li , Yanqi Fu , Jie Li , Wenqi Shen , Xiao Tan , Jinyi Wu , Ningjian Wang , Yingli Lu , Bin Wang
Introduction and Objectives
Tobacco exposure during critical developmental windows may have lasting health effects, but its role in the development of chronic liver disease (CLD) remains unclear. This study aimed to examine the association between early-life tobacco exposure and CLD incidence in adulthood.
Materials and Methods
We included 429,603 participants without prior liver diseases from the UK Biobank. Information on in utero tobacco exposure and the age of smoking initiation was extracted, categorized as never-smokers, adulthood (≥18 y), adolescence (15–17 y), and childhood (5–14 y). Composite CLD and individual endpoints, including non-alcoholic fatty liver disease (NAFLD), fibrosis/cirrhosis, alcohol-related liver disease (ALD), viral hepatitis, and liver cancer, were ascertained through electronic health records.
Results
After covariate adjustment, in utero tobacco exposure was associated with a greater risk of incident CLD (HR 1.27; 95 % CI 1.21, 1.34). A significant dose-response association was observed between the age of smoking initiation and CLD risk; the HRs (95 % CIs) for smoking initiation in adulthood, adolescence, and childhood were 1.45 (1.36, 1.54), 1.48 (1.40, 1.57), and 1.81 (1.68, 1.96), respectively (P trend <0.001). The results were similar for NAFLD, fibrosis/cirrhosis, and ALD. Participants with both in utero tobacco exposure and smoking initiation in childhood had the highest CLD risk (HR 2.22; 95 % CI 1.98, 2.48). Among participants who started smoking in childhood or adolescence, the risk of CLD was substantially reduced in those with smoking cessation in midlife compared to those who continued smoking. The mediation analysis indicated that metabolic traits including obesity-related traits, lipid profile, and liver function partially explained the association between early-life tobacco exposure and CLD incidence.
Conclusions
In utero and childhood/adolescence exposure to tobacco smoke was associated with an increased risk of CLD later in life.
简介和目的：在关键发育窗口期接触烟草可能对健康产生持久影响，但其在慢性肝病（CLD）发展中的作用尚不清楚。本研究旨在探讨早期吸烟与成年后CLD发病率之间的关系。材料和方法：我们从英国生物银行纳入了429,603名既往无肝脏疾病的参与者。提取子宫内烟草暴露和开始吸烟年龄的信息，分类为从不吸烟者、成年期（≥18岁）、青春期（15-17岁）和儿童期（5-14岁）。通过电子健康记录确定复合CLD和个体终点，包括非酒精性脂肪性肝病（NAFLD）、纤维化/肝硬化、酒精相关性肝病（ALD）、病毒性肝炎和肝癌。结果：经协变量调整后，子宫内接触烟草与CLD发生风险增加相关（HR 1.27; 95% CI 1.21, 1.34）。开始吸烟年龄与CLD风险之间存在显著的剂量-反应相关性；成年期、青春期和儿童期开始吸烟的hr （95% ci）分别为1.45（1.36,1.54）、1.48（1.40,1.57）和1.81 (1.68,1.96)（P趋势）。结论：子宫内和儿童期/青春期接触烟草烟雾与以后生活中CLD风险增加有关。
{"title":"Early-life exposure to tobacco smoke and chronic liver disease incidence in adulthood","authors":"Xiaoqin Xu , Jiang Li , Yanqi Fu , Jie Li , Wenqi Shen , Xiao Tan , Jinyi Wu , Ningjian Wang , Yingli Lu , Bin Wang","doi":"10.1016/j.aohep.2025.102168","DOIUrl":"10.1016/j.aohep.2025.102168","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Tobacco exposure during critical developmental windows may have lasting health effects, but its role in the development of chronic liver disease (CLD) remains unclear. This study aimed to examine the association between early-life tobacco exposure and CLD incidence in adulthood.</div></div><div><h3>Materials and Methods</h3><div>We included 429,603 participants without prior liver diseases from the UK Biobank. Information on in utero tobacco exposure and the age of smoking initiation was extracted, categorized as never-smokers, adulthood (≥18 y), adolescence (15–17 y), and childhood (5–14 y). Composite CLD and individual endpoints, including non-alcoholic fatty liver disease (NAFLD), fibrosis/cirrhosis, alcohol-related liver disease (ALD), viral hepatitis, and liver cancer, were ascertained through electronic health records.</div></div><div><h3>Results</h3><div>After covariate adjustment, in utero tobacco exposure was associated with a greater risk of incident CLD (HR 1.27; 95 % CI 1.21, 1.34). A significant dose-response association was observed between the age of smoking initiation and CLD risk; the HRs (95 % CIs) for smoking initiation in adulthood, adolescence, and childhood were 1.45 (1.36, 1.54), 1.48 (1.40, 1.57), and 1.81 (1.68, 1.96), respectively (<em>P</em> trend <0.001). The results were similar for NAFLD, fibrosis/cirrhosis, and ALD. Participants with both in utero tobacco exposure and smoking initiation in childhood had the highest CLD risk (HR 2.22; 95 % CI 1.98, 2.48). Among participants who started smoking in childhood or adolescence, the risk of CLD was substantially reduced in those with smoking cessation in midlife compared to those who continued smoking. The mediation analysis indicated that metabolic traits including obesity-related traits, lipid profile, and liver function partially explained the association between early-life tobacco exposure and CLD incidence.</div></div><div><h3>Conclusions</h3><div>In utero and childhood/adolescence exposure to tobacco smoke was associated with an increased risk of CLD later in life.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102168"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145628000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly common globally, but current diagnostic methods are inaccessible. This study aims to evaluate the efficacy of triglyceride glucose-body mass index (TyG-BMI) as a noninvasive diagnostic tool for MASLD.
Materials and Methods
Embase, PubMed, Cochrane Library, and Web of Science up to July 2025 were searched for related studies. Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 was utilized for quality assessment. The effect size, odds ratio (OR), specificity, sensitivity, positive/negative likelihood ratios, diagnostic odds ratio, and heterogeneity were pooled using Stata18.0 and Meta-Disc1.4. The summary receiver operating characteristic (SROC) curves were plotted and the area under the curve (AUC) values were calculated. Random- or fixed-effects models were adopted based on the results of the heterogeneity test. Moreover, we investigated the source and influence of heterogeneity by subgroup and sensitivity analyses, and examined publication bias.
Results
Twenty-nine studies were included. The meta-analysis revealed a higher TyG-BMI in MASLD patients than in non-MASLD patients (SMD 3.09, 95% CI 2.49–3.68, P < 0.001). For each one-unit increase in TyG-BMI, the MASLD risk rose by 5% (OR 1.05, 95% CI 1.04–1.07, P < 0.001). The pooled sensitivity, specificity, and AUC of the diagnostic efficacy of TyG-BMI were 0.81 (95% CI 0.77–0.85), 0.72 (95% CI 0.67–0.77), and 0.83 (95% CI 0.80–0.86), respectively. The stratified analysis by sex revealed that the diagnostic efficacy was superior in females (sensitivity: 0.82, specificity: 0.80).
Conclusions
TyG-BMI, a cost-efficient and convenient indicator, is favorable for diagnosing MASLD, especially in females, which is worth popularizing.
简介和目的：代谢功能障碍相关的脂肪变性肝病（MASLD）在全球范围内越来越普遍，但目前的诊断方法尚无法获得。本研究旨在评估甘油三酯葡萄糖体重指数（TyG-BMI）作为MASLD无创诊断工具的有效性。材料与方法：检索Embase、PubMed、Cochrane Library和Web of Science截至2025年7月的相关研究。采用诊断准确性研究质量评估(QUADAS)-2进行质量评估。使用Stata18.0和Meta-Disc1.4汇总效应大小、优势比（OR）、特异性、敏感性、阳性/阴性似然比、诊断优势比和异质性。绘制总体受试者工作特征（SROC）曲线，计算曲线下面积（AUC）值。根据异质性检验结果，采用随机或固定效应模型。此外，我们通过亚组分析和敏感性分析调查了异质性的来源和影响，并检查了发表偏倚。结果：纳入29项研究。meta分析显示，MASLD患者的TyG-BMI高于非MASLD患者（SMD为3.09,95% CI为2.49 ~ 3.68）。结论：TyG-BMI是一种成本效益高且方便的指标，有利于MASLD的诊断，尤其是女性，值得推广。
{"title":"Diagnosis of metabolic dysfunction-associated steatotic liver disease by triglyceride glucose-body mass index: A systematic review and meta-analysis","authors":"Kexin Du , Yafang Huang , Yanhui Yu, Jianrong Guo, Jianmei Feng, Feng Jiang","doi":"10.1016/j.aohep.2025.102122","DOIUrl":"10.1016/j.aohep.2025.102122","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly common globally, but current diagnostic methods are inaccessible. This study aims to evaluate the efficacy of triglyceride glucose-body mass index (TyG-BMI) as a noninvasive diagnostic tool for MASLD.</div></div><div><h3>Materials and Methods</h3><div>Embase, PubMed, Cochrane Library, and Web of Science up to July 2025 were searched for related studies. Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 was utilized for quality assessment. The effect size, odds ratio (OR), specificity, sensitivity, positive/negative likelihood ratios, diagnostic odds ratio, and heterogeneity were pooled using Stata18.0 and Meta-Disc1.4. The summary receiver operating characteristic (SROC) curves were plotted and the area under the curve (AUC) values were calculated. Random- or fixed-effects models were adopted based on the results of the heterogeneity test. Moreover, we investigated the source and influence of heterogeneity by subgroup and sensitivity analyses, and examined publication bias.</div></div><div><h3>Results</h3><div>Twenty-nine studies were included. The meta-analysis revealed a higher TyG-BMI in MASLD patients than in non-MASLD patients (SMD 3.09, 95% CI 2.49–3.68, P < 0.001). For each one-unit increase in TyG-BMI, the MASLD risk rose by 5% (OR 1.05, 95% CI 1.04–1.07, P < 0.001). The pooled sensitivity, specificity, and AUC of the diagnostic efficacy of TyG-BMI were 0.81 (95% CI 0.77–0.85), 0.72 (95% CI 0.67–0.77), and 0.83 (95% CI 0.80–0.86), respectively. The stratified analysis by sex revealed that the diagnostic efficacy was superior in females (sensitivity: 0.82, specificity: 0.80).</div></div><div><h3>Conclusions</h3><div>TyG-BMI, a cost-efficient and convenient indicator, is favorable for diagnosing MASLD, especially in females, which is worth popularizing.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102122"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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