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Physical activity as a treatment of non-alcoholic fatty liver disease:A systematic review

World Journal of Hepatology 2015年第16期7卷 2041-2052页

作者： Maureen Whitsett lisa b vanwagner Department of Medicine Division of Gastroenterology and Hepatology Northwestern University Feinberg School of Medicine Chicago

AIM: To review the effectiveness of exercise as a therapy for nonalcoholic fatty liver disease(NAFLD) and potential benefits in treating insulin resistance and ***: Medline(EbSCOhost) and Pub Med were searched for English-language randomized controlled trials and prospective cohort studies in human adults aged ≥ 18 which investigated the various effects of exercise alone, a combination of exercise and diet, or exercise and diet coupled with behavioral modification on NAFLD from 2010 to Feburary ***: Eighteen of 2298 available studies were chosen for critical review, which included 6925 patients. Nine(50%) studies were randomized controlled trials. Five(27.8%) studies utilized biopsy to examine the effects of physical activity on hepatic histology. The most commonly employed imaging modality to determine change in hepatic steatosis was hydrogen-magnetic resonance spectroscopy. Only two studies examined the effects of low impact physical activity for patients with significant mobility limitations and one compared the efficacy of aerobic and resistance exercise. No studies examined the exact duration of exercise required for hepatic and metabolic improvement in ***: While exercise improved hepatic steatosis and underlying metabolic abnormalities in NAFLD, more studies are needed to define the most beneficial form and duration of exercise treatment.

关键词： Nonalcoholic fatty liver disease Nonalcoholicsteatohepatitis Fatty liver Exercise Obesity

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Liver transplantation in the era of non-alcoholic fatty liver disease/metabolic(dysfunction)associated fatty liver disease:the dilemma of the steatotic liver graft on transplantation and recipient survival

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Hepatobiliary Surgery and Nutrition 2022年第3期11卷 425-429页

作者： Seren M.Gedallovich Daniela P.Ladner lisa b.vanwagner Division of Palliative Medicine Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA Division of Organ Transplantation Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoILUSA Division of Gastroenterology&Hepatology Department of MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA Division of Epidemiology Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA

Liver transplantation remains the only curative therapy for end-stage liver disease and there is a well-established shortage of transplantable deceased donor organs to meet the growing demand of waitlisted *** liver grafts represent the most common type of so-called extended criteria donor(ECD)grafts aimed at ameliorating this ***,steatotic grafts are associated with increased post-transplant complications and graft failure(1).Hepatic graft steatosis is strongly correlated with the high prevalence of non-alcoholic fatty liver disease(NAFLD)and metabolic(dysfunction)associated fatty liver disease(MAFLD)in the general *** and MAFLD are related,but not equivalent,liver disorders that are linked with obesity and diabetes(2).Global prevalence of NAFLD is estimated at~25%and rising(3).Models predict that NAFLD prevalence will increase by 21%to affect 100.9 million persons worldwide by 2030(4).As more donors have NAFLD,the steatotic liver graft will continue to be a challenge for liver ***,promising efforts(e.g.,organ pump with defatting agents)are under way,aimed at expanding the donor pool in the coming ***,we briefly summarize approaches for assessment of hepatic steatosis,describe recipient outcomes associated with the use of steatotic liver grafts,and highlight strategies that may be used to mitigate risk considering the ongoing NAFLD/MAFLD epidemic.

关键词： organs graft donor

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When evidence is lacking:a mixed-methods approach for the development of practice guidance in liver transplantation

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Gastroenterology Report 2021年第1期9卷 22-30,I0001页

作者： lisa b.vanwagner blessing Aghaulor Tasmeen Hussain Megan Kosirog Patrick Campbell Stewart Pine Amna Daud Daniel J.Finn Josh Levitsky Donald M.Lloyd-Jones Jane L.Holl Division of Gastroenterology and Hepatology Department of MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA Department of Preventive Medicine Northwestern University Feinberg School of MedicineChicagoILUSA Comprehensive Transplant Center Northwestern University Feinberg School of MedicineChicagoILUSA Division of Cardiology Department of MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA Department of Pediatrics Northwestern University Feinberg School of MedicineChicagoILUSA Center for Healthcare Delivery Science and Innovation and Department of Neurology Biological Sciences DivisionUniversity of ChicagoChicagoILUSA

background Most interventions for conditions with a small cohort size,such as transplantation,are unlikely to be part of a clinical *** condition-specific evidence is lacking,expert consensus can offer more precise guidance to improve *** of cardiovascular risk in liver-transplant recipients is one example for which clinicians have,to date,adapted evidence-based guidelines from studies in the general ***,even when consensus is achieved,implementation of practice guidance is often inadequate and *** report on a novel mixed-methods approach,the Northwestern MethodVC,for the development of clinical-practice guidance when condition-specific evidence is *** illustrate the method through the development of practice guidance for managing cardiovascular risk in liver-transplant *** The Northwestern MethodVC consists of(i)adaptation of relevant,existing,evidence-based clinical-practice guidelines for the target population;(ii)consensus by experts of the proposed practice guidance;(iii)identification of barriers to guidance adherence in current practice;and(iv)recommendation for implementation and dissemination of the practice *** method is based on an iterative,user-centered approach in which the needs,wants,and limitations of all end users,including patients,are attended to at each stage of the design and development *** The Northwestern MethodVC for clinical-practice-guidance development uses a mixed-methods approach to bring together broad representation from multiple disciplines and practice settings to develop consensus considering the unique needs and preferences of patients,caregivers,and practitioners who are directly impacted by clinical-practice-guidance *** hypothesize that a priori involvement of end users in the guidance-development process will lead to sustainable implementation of guidance statements into clinical practice.

关键词： liver transplantation practice guideline consensus methodology

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