Liver biopsy is the gold standard for the diagnosis of fatty liver disease. An Evolutionary-Based Framework for Analyzing Mold and Dampness Since non-alcoholic hepatic steatosis is regarded to be closely related to metabolic syndrome, multiple studies have investigated its associations with atherosclerotic diseases[59-61] and diabetes mellitus[62-65]. Therefore, pathologists are not able to distinguish between both entities by themselves without information on risk factors provided by clinicians[32,37,38]. Baumeister SE, Schumann A, Nakazono TT, Alte D, Friedrich N, John U, Vlzke H. Alcohol consumption and out-patient services utilization by abstainers and drinkers. The rationale for this distinction, however, has not yet been the issue of thorough analyses. And how do we name fatty liver disease if one or more additional risk factors listed in Figure Figure11 are present? Results for 'multicausality' 16 found. It has also not been stated what the indication of liver biopsy was in the non-alcoholic patients. This phenomenon may also have led to oversimplified interpretation of J-shaped associations between alcohol consumption and cardiovascular mortality[30,31] and should be considered in future studies on associations between alcohol consumption and fatty liver disease. Hotamisligil GS. Alzheimer's disease (AD) is a complex, multicausal disorder involving several spatiotemporal scales and scientific domains. on the one hand, the global food system sources its products from local food systems, creating an innate connection between natural resources, 9 multi-causality refers to outcomes that have. But in turn, the result itself was the cause of the international economic crisis that affected the world economy during the first half of 2009. Whereas the six patients with alcoholic fatty liver disease consumed a heavy amount of at least 180 g alcohol daily, the relatively moderate inclusion criterion for the non-alcoholic fatty liver disease group was to be at least 30% overweight in terms of ideal standards for height[35]. Modest wine drinking and decreased prevalence of suspected nonalcoholic fatty liver disease. . Survival was similar between patients with alcoholic and non-alcoholic steatohepatitis. Multicausality and Equifinality | Politics Trove Meisinger C, Heier M, Vlzke H, Lwel H, Mitusch R, Hense HW, Ldemann J. both experimental and observational research is to minimize all sources of variability other than the one whose effects are being observed. c. organization or activity that is self-perpetuating and valued for its own sake. Non-alcoholic and alcoholic fatty liver disease - two diseases of affluence associated with the metabolic syndrome and type 2 diabetes: the FIN-D2D survey. Hepatic complications: Pure hepatic steatosis is commonly regarded as a benign disorder. Furthermore, although Pinto et al[13] provide data on medication taken by the study patients, they leave uncertainty whether liver-related side effects of these drugs were suspected by treating physicians. At least five common mechanisms exist that are important for the development and progression of both alcoholic and non-alcoholic fatty liver disease. In multicausality, the result or consequence of being a cause for another multicausal event is not exempted. The core principles of multicausality's - Assignment Den Fatty liver disease is common in populations and has potential consequences for individual health. Finally, misclassification due to information bias represents a serious problem in correctly distinguishing between alcoholic and non-alcoholic forms of fatty liver disease. In fact, under causal determinism, it is considered that all events in the universe are the result of a level of multicausality so complex that it becomes confused with chance. The .gov means its official. Naveau S, Thaury J, Barri-Ova N, Balian A, Dauvois B, Njik-Nakseu M, Prvot S, Agostini H, Perlemuter G. Predictive factors for pure steatosis in alcoholic patients. Taken together, it is still not clear whether extrahepatic complications of non-alcoholic fatty liver disease are specific for the metabolic origin. "Causal", in this case, works as a noun meaning motive, reason or factor that produces something else. PDF 13. Multicausality - analysis approaches - epidemiolog As mentioned earlier, this finding might be explained by the more advanced disease stage of hospitalized alcoholics, when compared to patients with non-alcoholic steatohepatitis at the time of recruitment. Why multivariate research designs? Data observable evidence used to test a theory (aka tests hy-pothesis) 4. Taken together, the definitions of alcoholic and non-alcoholic fatty liver disease are not very practical for clinical applications. This chapter evaluates multicausality and equifinality, which refer to a research situation whereby an outcome is explained by more than one causal factor. Also, in both disease forms, inflammatory cytokines reduce insulin sensitivity and thereby increase the risk of fatty liver disease[45-47]. Nanda K. Non-alcoholic steatohepatitis in children. (PDF) Bryman & bell -research methods - Academia.edu Unfortunately, subjects with alcohol consumption of between 20 g and < 80 g are not assigned to a specific group. This site needs JavaScript to work properly. The Dionysos Study Group. Questions are raised about persisting tendencies to split mind from body by attributing pain to either organic or psychological causes. Tannapfel A, Denk H, Dienes HP, Langner C, Schirmacher P, Trauner M, Flott-Rahmel B. Histopathological diagnosis of non-alcoholic and alcoholic fatty liver disease. The columns indicate the proportions of metabolic syndrome (MetS), increased serum carbohydrate-deficient transferrin (CDT > 6%), the combined presence of both risk factors in all subjects (970 men, 685 women) and subjects with a hyperechogenic pattern on liver ultrasound (486 men, 288 women), in whom at least one of both risk factors was present. Fraser A, Harris R, Sattar N, Ebrahim S, Davey Smith G, Lawlor DA. From the clinical perspective, it would be highly valuable to explore risk scores similar to those scores established for coronary artery disease[80] or diabetes mellitus[81], for instance. Sharma JC. The knowledge behind this term is based on the fact that the concept of the cause and causal inferences are mostly connected. Secondly, with regard to hepatic steatosis, there is no consistent definition of alcohol misuse. Alanine aminotransferase, gamma-glutamyltransferase, and incident diabetes: the British Womens Heart and Health Study and meta-analysis. A model of causation that describes causes in terms of sufficient causes and their component causes illuminates important principles such as multicausality, the dependence of the strength of component causes on the prevalence of complementary component causes, and interaction between component causes. Adams LA, Waters OR, Knuiman MW, Elliott RR, Olynyk JK. The columns indicate the proportions of obesity (Ob; body mass index > 30 kg/m), harmful alcohol consumption (Alc; daily alcohol consumption > 20 g in women and > 30 g in men), the combined presence of both risk factors in all subjects (1122 men, 781 women) and subjects with a hyperechogenic pattern on liver ultrasound (535 men, 276 women), in whom at least one of both risk factors was present. Multicausality is also studied from the philosophical perspective, statistics, computation and especially in physics. The sufficient-component cause model is one of several conceptual models for causation that appeared in the 1970s in response to the problem of multicausality in chronic diseases. Bugianesi E, Leone N, Vanni E, Marchesini G, Brunello F, Carucci P, Musso A, De Paolis P, Capussotti L, Salizzoni M, et al. Clinicopathological comparison with alcoholic hepatitis in ambulatory and hospitalized patients. Hence, it is unclear whether the less severe clinical status in non-alcoholic steatohepatitis patients and the earlier liver biopsy account for the lower severity of histopathological findings compared to patients with alcoholic steatohepatitis. The keywords used were alcoholic or non-alcoholic and fatty liver or hepatic steatosis or steatohepatitis or cirrhosis. 0000002593 00000 n In Southern Italy, it was estimated from a population-based study[3] that alcohol misuse accounted for 46.5% of all cases diagnosed with impaired liver function, and a further 24.0% of cases were attributed to non-alcoholic fatty liver disease. Dumas O, Siroux V, Le Moual N, Varraso R. Rev Epidemiol Sante Publique. Fatty liver disease parallels other multicausal diseases in many aspects. Multicausality in clinical trials means a A problem with an outcome that has. Nonalcoholic fatty liver disease. Nonalcoholic steatohepatitis--a long-term follow-up study: comparison with alcoholic hepatitis in ambulatory and hospitalized patients. The current concept to distinguish between alcoholic and non-alcoholic fatty liver disease is mainly based on the presence of alcohol misuse and obesity-related metabolic disorders as common risk factors and, at least evident for the early phase of the disease, specific pathogenetic mechanisms. The suffix"-idad"is used at the end of a word to describe the word that precedes as a quality; for example,"sonority"implies that something has a sound quality. [Health Risk drinking and problematic consumption of alcohol in Pomerania: comparative analysis of the Study of Health in Pomerania (SHIP) compared with the Federal German Health and Examination Survey in 1998]. Patients with non-alcoholic steatohepatitis as well as ambulatory and hospitalized patients with alcoholic hepatitis were followed up over a mean time of six years. A shift from artificial categories to a more general approach to fatty liver disease as a multicausal disorder may optimize preventive strategies and help clinicians more effectively treat patients at the individual level. O. Observational Methods: Combining Critical Distance and Inside Knowledge? PMC This more general perspective is particularly necessary, given the overlap between risk factors and their potential interactions. Meisinger C, Lwel H, Heier M, Schneider A, Thorand B. Serum gamma-glutamyltransferase and risk of type 2 diabetes mellitus in men and women from the general population. 41 Ust Kaynarca, Pendik, Istanbul 34899, Turkey, S- Editor Cheng JX L- Editor Logan S E- Editor Zheng XM, Correspondence to: Henry Vlzke, MD, Professor, Institute for Community Medicine, University of Greifswald, Walther Rathenau Str. Genetics of alcoholic liver disease and nonalcoholic fatty liver disease. Pages 6 This preview shows page 2 - 4 out of 6 pages. Wannamethee G, Shaper AG. Rather, a broad overlap between both characteristics exists, particularly in men. The most efficient risk factor reduction can be achieved by lifestyle changes. [Multi-causality in nursing work accidents with biological material] Multicausality entails the nature of having many causes in one single variable. Dunn W, Xu R, Schwimmer JB. Cortez-Pinto H, Baptista A, Camilo ME, De Moura MC. In cardiovascular medicine, however, there is no concept to distinguish between tobacco and non-tobacco-related atherosclerosis. PNPLA3: Patatin-like phospholipase domain-containing protein 3; PCOS: Polycystic ovary syndrome. In other important aspects, pathomechanisms leading to alcoholic as well as non-alcoholic fatty liver disease share many similarities. Conclusion: The higher grades of lobular inflammation, fibrosis and cirrhosis might well be explained by unbalanced risk factors in that study[37]. Most of these studies[59,61-63,65], however, used the relatively unspecific serum transaminase levels to define the exposure variables and commonly did not compare the risks of the outcomes between subjects with non-alcoholic and alcohol-related fatty liver disease. Reciprocal relationships between insulin resistance and endothelial dysfunction: molecular and pathophysiological mechanisms. 0000010550 00000 n The general aim of this review is to summarize the evidence that alcohol and "non-alcoholic" fatty liver diseases represent one and the same disorder with an underlying multicausal origin. Given the expected increase in the global burden of overweight and obesity[7], the prevalence of non-alcoholic fatty liver disease will continue to rise over the next years. SHIP is conducted in Northeast Germany, where both metabolic syndrome and alcohol misuse are highly prevalent and, consequently, hepatic steatosis is also commonly found on liver ultrasound[11]. These estimates include the influence of other extraneous variables, such as confounders. Data are taken from the population-based Study of Health in Pomerania. This compound term is widely used in the social and natural sciences. It still remains to be determined, however, whether it is also possible to conclude that non-alcoholic steatohepatitis has a less severe histopathological pattern than the alcoholic form, because additional information on the clinical status of the patients would be necessary. Haring R, Alte D, Vlzke H, Sauer S, Wallaschofski H, John U, Schmidt CO. Extended recruitment efforts minimize attrition but not necessarily bias. 164 0 obj << /Linearized 1 /O 175 /H [ 1936 679 ] /L 165088 /E 42587 /N 33 /T 161689 >> endobj xref 164 42 0000000016 00000 n The columns indicate the proportions of metabolic syndrome, Thaler H. [Fatty liver, its causes and concomitant diseases]. Similar findings were found in Finish adults[20], where subjects with alcoholic fatty liver disease were as often obese as subjects with non-alcoholic fatty liver disease, and the metabolic syndrome was even more common in alcoholic than in non-alcoholic fatty liver disease. After applying stricter definitions for risk factors, metabolic syndrome[19] and increased serum carbohydrate-deficient transferrin levels are co-existent in 9.0% of men with at least one of both risk factors in the whole study population and in 11.7% in men with risk factors and liver hyperechogenicity, respectively (Figure (Figure3).3). The multicausality in the social determination is utilized in the act of understanding the human process. Copyright 2011 Elsevier Masson SAS. Similar findings have been documented for non-alcoholic fatty liver disease. Disclaimer, National Library of Medicine PDF 11. 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