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  • 1. Aims and Scope

    Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE

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    Editor-in-Chief
    Yong Chan Lee Professor of Medicine
    Director, Gastrointestinal Research Laboratory
    Veterans Affairs Medical Center, Univ. California San Francisco
    San Francisco, USA

    Deputy Editor

    Deputy Editor
    Jong Pil Im Seoul National University College of Medicine, Seoul, Korea
    Robert S. Bresalier University of Texas M. D. Anderson Cancer Center, Houston, USA
    Steven H. Itzkowitz Mount Sinai Medical Center, NY, USA
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    All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
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Letter to the Editor

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Comments on Relationship between the High Fatty Liver Index and Risk of Fracture

Shih-Wei Lai1,2 , Kuan-Fu Liao3,4

1Department of Public Health, College of Public Health, and Department of Medicine, College of Medicine, China Medical University, 2Department of Family Medicine, China Medical University Hospital, Taichung, 3College of Medicine, Tzu Chi University, Hualien, and 4Division of Hepatogastroenterology, Department of Internal Medicine, Taichung Tzu Chi Hospital, Taichung, Taiwan

Correspondence to: Shih-Wei Lai
ORCID https://orcid.org/0000-0002-7420-1572
E-mail wei@mail.cmuh.org.tw

Received: January 18, 2023; Revised: January 19, 2023; Accepted: January 26, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gut Liver 2023;17(4):661-662. https://doi.org/10.5009/gnl230021

Published online April 6, 2023, Published date July 15, 2023

Copyright © Gut and Liver.

To the Editor:

A retrospective cohort study performed by Kim et al.1 demonstrated that persons with a high fatty liver index would have a high risk of osteoporotic fracture. Some points should be discussed. First, nonalcoholic fatty liver disease is a disorder in which excess fat accumulates in the liver among persons who drink little or no alcohol.2 That is, nonalcoholic fatty liver disease is not caused by alcohol, but it is caused by other nonalcoholic etiologies. Any clinical research exploring nonalcoholic fatty liver disease should include persons who drink little or no alcohol as study subjects. However, Table 1 in the study of Kim et al.1 shows the baseline data of alcohol consumption among study subjects. These data indicate that these study subjects had drunk alcohol, and thus, their fatty liver could have been caused by alcohol. This goes against the definition of nonalcoholic fatty liver disease. It is not suitable to select persons with a history of drinking alcohol to explore nonalcoholic fatty liver disease. Therefore, Kim et al.’s data might include both nonalcoholic and alcoholic fatty liver disease. Second, the database used in Kim et al.’s study has big data. The authors have an ability to conduct a new analysis focusing on persons who drink little or no alcohol. Thus, the relationship between nonalcoholic fatty liver disease and the risk of osteoporotic fracture could be clarified. Until a new analysis is done, the findings thus far in Kim et al.’s study1 are not sound. Third, owing to the limitation of the database used, whether the fractures were “osteoporotic” or “traumatic” could not be differentiated in Kim et al.’s study.1 However, falls still are the main cause of fractures. We agree with Kim et al.’s comments that we should pay more attention to persons with a high fatty liver index, such as by intervention with fall-prevention strategies,3 and then subsequent fracture events can be reduced (Fig. 1).

Figure 1.A reasonable hypothesis between a high fatty liver index, potential risk factors, falls and fractures.

No potential conflict of interest relevant to this article was reported.

  1. Kim MJ, Kim MS, Lee HB, Roh JH, Jeon JH. Relationship between the high fatty liver index and risk of fracture. Gut Liver 2023;17:119-129.
    Pubmed KoreaMed CrossRef
  2. American College of Gastroenterology (ACG). Non-alcoholic fatty liver disease (NAFLD) [Internet]. North Bethesda: AGC; c2023 [cited 2023 Jan 1].
    Available from: https://gi.org/topics/fatty-liver-disease-nafld/.
  3. Lai SW. Diabetes mellitus and hip fracture. Osteoporos Int 2022;33:953-954.
    Pubmed CrossRef

Article

Letter to the Editor

Gut and Liver 2023; 17(4): 661-662

Published online July 15, 2023 https://doi.org/10.5009/gnl230021

Copyright © Gut and Liver.

Comments on Relationship between the High Fatty Liver Index and Risk of Fracture

Shih-Wei Lai1,2 , Kuan-Fu Liao3,4

1Department of Public Health, College of Public Health, and Department of Medicine, College of Medicine, China Medical University, 2Department of Family Medicine, China Medical University Hospital, Taichung, 3College of Medicine, Tzu Chi University, Hualien, and 4Division of Hepatogastroenterology, Department of Internal Medicine, Taichung Tzu Chi Hospital, Taichung, Taiwan

Correspondence to:Shih-Wei Lai
ORCID https://orcid.org/0000-0002-7420-1572
E-mail wei@mail.cmuh.org.tw

Received: January 18, 2023; Revised: January 19, 2023; Accepted: January 26, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Body

To the Editor:

A retrospective cohort study performed by Kim et al.1 demonstrated that persons with a high fatty liver index would have a high risk of osteoporotic fracture. Some points should be discussed. First, nonalcoholic fatty liver disease is a disorder in which excess fat accumulates in the liver among persons who drink little or no alcohol.2 That is, nonalcoholic fatty liver disease is not caused by alcohol, but it is caused by other nonalcoholic etiologies. Any clinical research exploring nonalcoholic fatty liver disease should include persons who drink little or no alcohol as study subjects. However, Table 1 in the study of Kim et al.1 shows the baseline data of alcohol consumption among study subjects. These data indicate that these study subjects had drunk alcohol, and thus, their fatty liver could have been caused by alcohol. This goes against the definition of nonalcoholic fatty liver disease. It is not suitable to select persons with a history of drinking alcohol to explore nonalcoholic fatty liver disease. Therefore, Kim et al.’s data might include both nonalcoholic and alcoholic fatty liver disease. Second, the database used in Kim et al.’s study has big data. The authors have an ability to conduct a new analysis focusing on persons who drink little or no alcohol. Thus, the relationship between nonalcoholic fatty liver disease and the risk of osteoporotic fracture could be clarified. Until a new analysis is done, the findings thus far in Kim et al.’s study1 are not sound. Third, owing to the limitation of the database used, whether the fractures were “osteoporotic” or “traumatic” could not be differentiated in Kim et al.’s study.1 However, falls still are the main cause of fractures. We agree with Kim et al.’s comments that we should pay more attention to persons with a high fatty liver index, such as by intervention with fall-prevention strategies,3 and then subsequent fracture events can be reduced (Fig. 1).

Figure 1. A reasonable hypothesis between a high fatty liver index, potential risk factors, falls and fractures.

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Fig 1.

Figure 1.A reasonable hypothesis between a high fatty liver index, potential risk factors, falls and fractures.
Gut and Liver 2023; 17: 661-662https://doi.org/10.5009/gnl230021

References

  1. Kim MJ, Kim MS, Lee HB, Roh JH, Jeon JH. Relationship between the high fatty liver index and risk of fracture. Gut Liver 2023;17:119-129.
    Pubmed KoreaMed CrossRef
  2. American College of Gastroenterology (ACG). Non-alcoholic fatty liver disease (NAFLD) [Internet]. North Bethesda: AGC; c2023 [cited 2023 Jan 1]. Available from: https://gi.org/topics/fatty-liver-disease-nafld/.
  3. Lai SW. Diabetes mellitus and hip fracture. Osteoporos Int 2022;33:953-954.
    Pubmed CrossRef
Gut and Liver

Vol.18 No.3
May, 2024

pISSN 1976-2283
eISSN 2005-1212

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