Clinically significant chronic liver disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study

Background: Type 2 diabetes is an independent risk factor for chronic liver disease, however disease burden estimates and knowledge of prognostic indicators are lacking in community populations. Aims: To describe the prevalence and incidence of clinically significant chronic liver disease amongst community-based older people with Type 2 diabetes and to determine risk factors which might assist in discriminating patients with unknown prevalent or incident disease. Design: Prospective cohort study. Methods: Nine hundred and thirty-nine participants in the Edinburgh Type 2 Diabetes Study underwent investigation including liver ultrasound and non-invasive measures of non-alcoholic steatohepatitis (NASH), hepatic fibrosis and systemic inflammation. Over 6-years, cases of cirrhosis and hepatocellular carcinoma were collated from multiple sources. Results: Eight patients had known prevalent disease with 13 further unknown cases identified (prevalence 2.2%) and 15 incident cases (IR 2.9/1000 person-years). Higher levels of systemic inflammation, NASH and hepatic fibrosis markers were associated with both unknown prevalent and incident clinically significant chronic liver disease (all P < 0.001). Conclusions: Our study investigations increased the known prevalence of clinically significant chronic liver disease by over 150%, confirming the suspicion of a large burden of undiagnosed disease. The disease incidence rate was lower than anticipated but still much higher than the general population rate. The ability to identify patients both with and at risk of developing clinically significant chronic liver disease allows for early intervention and clinical monitoring strategies. Ongoing work, with longer follow-up, including analysis of rates of liver function decline, will be used to define optimal risk prediction tools

Systematic review with meta-analysis: coffee consumption and the risk of cirrhosis

Background: Liver cirrhosis is a large burden on global health, causing over one million deaths per year. Observational studies have reported an inverse association between coffee and cirrhosis.Aims: To perform a systematic review and meta-analysis to characterise the relationship between coffee consumption and cirrhosis.Methods: We searched for studies published until July 2015 that reported odds ratios, relative risks (RR) or hazard ratios for cirrhosis stratified by coffee consumption. We calculated RRs of cirrhosis for an increase in daily coffee consumption of two cups for each study and overall. We performed analyses by study design, type of cirrhosis and mortality. We assessed the risk of bias in each study and the overall quality of evidence for the effect of coffee on cirrhosis.Results: We identified five cohort studies and four case–control studies involving 1990 cases and 432 133 participants. We observed a dose–response in most studies and overall. The pooled RR of cirrhosis for a daily increase in coffee consumption of two cups was 0.56 (95% CI 0.44–0.68; I2 83.3%). The RR pooled from cohort studies for a daily increase of two cups was 0.58 (95% CI 0.41–0.76; I2 91.1%) and from case–control studies it was 0.52 (95% CI 0.40–0.63; I2 0.0%). The pooled RR of alcoholic cirrhosis for a daily increase of two cups was 0.62 (95% CI 0.51–0.73; I2 0%) and of death from cirrhosis it was 0.55 (95% CI 0.35–0.74; I2 90.3%).Conclusion: This meta-analysis suggests that increasing coffee consumption may substantially reduce the risk of cirrhosis

Distress, the 6(th) vital sign in cancer care Caring for patients’ emotional needs: what does this mean and what helps?

Distress has been endorsed as the 6(th) Vital Sign by the International Psycho-Oncology Society (IPOS) in 2009 with Screening for Distress as a proposed IPOS strategy in 2010. The need for skilled psychological care is well-recognized as a necessary, integral part of oncology care. There has been significant development of this field over the last two decades in the area now commonly labelled “psycho-oncology”. Given the advances in psycho-oncology, it is helpful to overview the approaches to provision of psychological care, so we can better understand how to care for the emotional needs of cancer patients, their partners and families. The focus here is on patients with high and enduring levels of need in terms of emotional functioning and the formal therapies that are available to help patients and their families manage these needs