Study Results
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Basic Information
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COMPLETED
5340 participants
OBSERVATIONAL
2022-08-01
2022-10-31
Brief Summary
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The study applies the Forns Score as a validated non-invasive tool for assessing liver fibrosis risk and incorporates the latest EASL-AASLD 2024 guidelines to define MASLD, MASH, Alcohol-Related Liver Disease (ALD), and MetALD (combined metabolic and alcohol-related liver disease). Additionally, it will explore potential underdiagnosis rates of liver disease by comparing clinical risk markers with documented diagnoses.
The study is a post hoc, cross-sectional, retrospective analysis and does not involve new data collection or patient contact. Data analysis will be performed using descriptive statistics, subgroup comparisons, and multivariate models to assess relationships between metabolic risk factors, MASLD probability, and liver disease awareness. This research will contribute to the understanding of MASLD epidemiology in Romania and inform public health strategies for early detection and prevention.
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Detailed Description
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This study is designed as a post hoc analysis of data from the European Health Examination Survey (EHES) - Romania, focusing on MASLD risk factors and advanced liver disease probability. The EHES is a large-scale population survey conducted in European countries, with standardized methodologies for data collection, ensuring comparability across different nations.
Study Objectives Primary Objective: Define an at-risk MASLD population in Romania.
Secondary Objectives:
Identify additional liver disease risk factors (viral hepatitis, iron overload, alcohol consumption).
Identify a population of confirmed advanced liver disease patients. Assess hepatitis prevalence vs. disease awareness (ICD-10 coding). Identify potential risk factors associated with hepatitis.
Study Design and Methodology Study Type: Observational, cross-sectional, retrospective. Data Source: EHES Romania dataset. Population: Adults (≥18 years) included in the EHES survey. Exclusion Criteria: Missing Forns Score variables (platelet count, total cholesterol, gamma-glutamyl transferase, age).
Sample Size Estimation: Based on MASLD prevalence (25-30%), minimum n=1000-1500 for subgroup analyses. (5300 available) Definition of Liver Disease Subtypes (EASL-AASLD 2024 Guidelines) MASLD: Hepatic steatosis with at least one metabolic risk factor. MASH: Progressive MASLD with hepatocellular injury and fibrosis. ALD: Liver disease in individuals exceeding alcohol thresholds (≥30g/day men, ≥20g/day women).
MetALD: Overlap of MASLD and ALD.
Statistical Analysis Plan Descriptive statistics for population characteristics and MASLD prevalence. Subgroup comparisons (MASLD vs. non-MASLD, ALD vs. non-ALD, etc.). Multivariate logistic regression for risk factor associations. Sensitivity analysis for missing data handling. Quality Assurance and Data Management EHES follows standardized data validation, quality control, and external audits.
Data checks and verification against medical records ensure accuracy. No new data collection or patient interaction in this study.
Ethical Considerations The EHES obtained informed consent from all participants \[PMID: 39491016\]. This study uses anonymized, pre-existing data. No ethical approval needed beyond EHES compliance. Data Sharing Statement Individual participant data will not be publicly available. Aggregated results will be shared upon request. Funding Statement No external funding. Study Timeline Data analysis starts: 20/02/2025 Expected completion:1/04/2025
Conditions
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Study Design
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COHORT
CROSS_SECTIONAL
Study Groups
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MASLD-At-Risk Cohort
Individuals meeting MASLD criteria based on metabolic dysfunction risk factors and hepatic steatosis.
No interventions assigned to this group
MASH Cohort
Subgroup with MASLD who meet additional criteria for hepatic inflammation and fibrosis risk.
No interventions assigned to this group
Alcohol-Related Liver Disease (ALD) Cohort:
Participants exceeding alcohol consumption thresholds who exhibit liver dysfunction and no other risk factors for liver diseas
No interventions assigned to this group
MetALD Cohort:
Individuals exhibiting both MASLD and ALD characteristics, requiring combined metabolic and alcohol-related assessment and no other risk factors for liver disease
No interventions assigned to this group
Non-MASLD Control Group
Participants with no significant metabolic dysfunction and normal liver function and no other risk factors for liver disease serving as a reference population.
No interventions assigned to this group
Eligibility Criteria
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Inclusion Criteria
* Participation in the EHES Romania study
Exclusion Criteria
* Missing biochemical data (ALT, GGT, platelets, cholesterol)
* Missing clinical and anthropometric data (age, weight and height)
18 Years
65 Years
ALL
Yes
Sponsors
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Transilvania University of Brasov
OTHER
Internist.Ro
OTHER
Responsible Party
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Locations
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Transylvania University School of Medicine
Brasov, Brașov County, Romania
National Institute for Public Health
Bucharest, Bucharest, Romania
Countries
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References
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Brinduse LA, Eclemea I, Neculau AE, Paunescu BA, Bratu EC, Cucu MA. Rural versus urban healthcare through the lens of health behaviors and access to primary care: a post-hoc analysis of the Romanian health evaluation survey. BMC Health Serv Res. 2024 Nov 4;24(1):1341. doi: 10.1186/s12913-024-11861-9.
Forns X, Ampurdanes S, Llovet JM, Aponte J, Quinto L, Martinez-Bauer E, Bruguera M, Sanchez-Tapias JM, Rodes J. Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology. 2002 Oct;36(4 Pt 1):986-92. doi: 10.1053/jhep.2002.36128.
Pimpin L, Cortez-Pinto H, Negro F, Corbould E, Lazarus JV, Webber L, Sheron N; EASL HEPAHEALTH Steering Committee. Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies. J Hepatol. 2018 Sep;69(3):718-735. doi: 10.1016/j.jhep.2018.05.011. Epub 2018 May 17.
Peacock A, Leung J, Larney S, Colledge S, Hickman M, Rehm J, Giovino GA, West R, Hall W, Griffiths P, Ali R, Gowing L, Marsden J, Ferrari AJ, Grebely J, Farrell M, Degenhardt L. Global statistics on alcohol, tobacco and illicit drug use: 2017 status report. Addiction. 2018 Oct;113(10):1905-1926. doi: 10.1111/add.14234. Epub 2018 Jun 4.
Stival C, Lugo A, Odone A, van den Brandt PA, Fernandez E, Tigova O, Soriano JB, Jose Lopez M, Scaglioni S, Gallus S; TackSHS Project Investigators. Prevalence and Correlates of Overweight and Obesity in 12 European Countries in 2017-2018. Obes Facts. 2022;15(5):655-665. doi: 10.1159/000525792. Epub 2022 Aug 2.
Younossi ZM. Non-alcoholic fatty liver disease - A global public health perspective. J Hepatol. 2019 Mar;70(3):531-544. doi: 10.1016/j.jhep.2018.10.033. Epub 2018 Nov 9.
Younossi Z, Anstee QM, Marietti M, Hardy T, Henry L, Eslam M, George J, Bugianesi E. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2018 Jan;15(1):11-20. doi: 10.1038/nrgastro.2017.109. Epub 2017 Sep 20.
Other Identifiers
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PDP1/NT2311/13.05.2020
Identifier Type: OTHER
Identifier Source: secondary_id
A002
Identifier Type: -
Identifier Source: org_study_id
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