Elucidating individual and neighborhood factors associated with nonalcoholic fatty liver disease (NAFLD)

建议的补充研究项目： 阐明与非酒精性脂肪性肝病(NAFLD)相关的个体和邻近因素 摘要： 虽然美国的总体癌症发病率正在下降，但肝癌的发病率超过了 在过去的40年里增长了两倍，使其成为美国上升最快的癌症。肝癌死亡率排名第五 男性和女性癌症死亡的第七大原因分别是。非酒精性脂肪肝 疾病(NAFLD)影响着大约30%的美国成年人口，已迅速成为导致 慢性肝病，并日益被认为是发展为肝癌的一个重要危险因素。 识别和减少暴露于潜在可改变的危险因素可以降低发病率和死亡率 与NAFLD的长期后遗症有关，包括肝硬变和肝癌。已确定的风险因素 非酒精性脂肪肝包括肥胖、2型糖尿病、老年、高血压、血脂异常和代谢综合征。 研究表明，邻里因素可能与NAFLD的发展和 通过胰岛素抵抗和肠道菌群改变而进展为肝癌。然而，没有研究表明 考察了社会和建筑环境属性与NAFLD之间的关系。我们提出了一个 加州大学旧金山分校(UCSF)对来自三个医疗系统的约200万名患者进行的前瞻性队列研究 卫生系统和旧金山卫生网络)和夏威夷(Kaiser Permanente Hawaii)来解决这些问题 研究空白。利用这一种族/民族和社会经济多样化的队列，这项拟议的研究 将检查与NAFLD相关的多层次风险因素(社会、行为、临床和社区)， 包括对那些以前未被诊断为NAFLD的患者进行鉴定。我们将与旧金山进行接触 癌症倡议(SFCAN)，这是一个当地社区合作伙伴关系，专注于减轻旧金山的癌症负担 弗朗西斯科，用于解释和传播成果。识别个人和社区层面的风险 这些因素与未来的有针对性的干预措施有关，这些干预措施将对解决这些差异至关重要。

Proposed Supplement Research Project: Elucidating individual and neighborhood factors associated with nonalcoholic fatty liver disease (NAFLD) Abstract: While overall cancer rates are declining in the United States (U.S.), liver cancer incidence has more than tripled in the last four decades, making it the fastest rising cancer in the U.S. Liver cancer mortality is the fifth and seventh leading causes of cancer death among men and women, respectively. Nonalcoholic fatty liver disease (NAFLD) affects about 30% of the U.S. adult population, has rapidly become a leading cause of chronic liver disease, and is increasingly recognized as an important risk factor for developing liver cancer. Identifying and mitigating exposure to potentially modifiable risk factors can reduce the morbidity and mortality related to long-term sequelae of NAFLD, including cirrhosis and liver cancer. Established risk factors for NAFLD include obesity, type 2 diabetes, older age, hypertension, dyslipidemia, and metabolic syndrome. Studies have suggested that neighborhood factors may be associated with NAFLD development and progression to liver cancer through insulin resistance and altered gut flora. However, no studies have examined the relationship between social and built environment attributes and NAFLD. We propose a prospective cohort study of approximately 2 million patients from three healthcare systems in California (UCSF Health System and San Francisco Health Network) and Hawaii (Kaiser Permanente Hawaii) to address these research gaps. Leveraging this racially/ethnically and socioeconomically diverse cohort, this proposed study will examine multilevel risk factors (social, behavioral, clinical, and neighborhood) associated with NAFLD, including identification of those with previously undiagnosed NAFLD. We will engage with the San Francisco Cancer Initiative (SFCAN), a local community partnership focused on reducing cancer burden in San Francisco, for interpretation and dissemination of results. Identifying individual- and neighborhood-level risk factors are relevant for future targeted interventions that will be critical to address these disparities.