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Vol.17 No.5
September, 2023
Frequency : Bimonthly
pISSN 1976-2283
eISSN 2005-1212 
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
| Yong Chan Lee |
Professor of Medicine Director, Gastrointestinal Research Laboratory Veterans Affairs Medical Center, Univ. California San Francisco San Francisco, USA |
| 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 |
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.
The remaining articles are usually sent to two reviewers. It would be very helpful if you could suggest a selection of reviewers and include their contact details. We may not always use the reviewers you recommend, but suggesting reviewers will make our reviewer database much richer; in the end, everyone will benefit. We reserve the right to return manuscripts in which no reviewers are suggested.
The final responsibility for the decision to accept or reject lies with the editors. In many cases, papers may be rejected despite favorable reviews because of editorial policy or a lack of space. The editor retains the right to determine publication priorities, the style of the paper, and to request, if necessary, that the material submitted be shortened for publication.
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Min-Ji Kim1 
, Jae-Hyung Roh2 , Jae-Han Jeon1
Correspondence to: Jae-Han Jeon
ORCID https://orcid.org/0000-0002-9217-968X
E-mail jeonjh@knu.ac.kr
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):663-664. https://doi.org/10.5009/gnl230035
Published online April 6, 2023, Published date July 15, 2023
Copyright © Gut and Liver.
We appreciate Dr. Lai and his colleagues’ interest and comments1 on our article entitled “Relationship between the High Fatty Liver Index and Risk of Fracture,” which was published in the journal
We agree with Dr. Lai and colleagues that studies into the relationship between NAFLD and risk of fracture should only include study subjects with little or no alcohol consumption. At the same time, we would like to emphasize that the definition of NAFLD is a weekly alcohol consumption of less than 210 g in men and 140 g in women, according to the guideline of the European Association for the Study of the Liver3,4 and the Korean Association for the Study of Liver NAFLD guidelines.5 In our study, the alcohol consumptions in the fatty liver index (FLI) quartile groups were Q1: 36.7±83.9, Q2: 60.0±112.9, Q3: 87.1±142.0, and Q4: 139.9±189.6 g/wk,2 indicating that most, if not all, of the subjects drank less alcohol than that stipulated in the NAFLD guidelines. Additionally, we excluded 190,883 patients with known liver disease. Although alcohol consumption is an important factor in the progression of fatty liver disease, the highest mean amount of alcohol consumption in Q4 was less than 140 g/wk. In subgroup analysis of the original article,2 we analyzed the data after dividing the subjects into three groups according to their weekly alcohol consumption (0, 1–139, and ≥140 g). The data showed no significant difference in the hazard ratio between the three groups (alcohol consumption=0 g/wk group: hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.04 to 1.17; alcohol consumption=1–139 g/wk group: HR, 1.13; 95% CI, 1.00 to 1.26; alcohol consumption ≥140 g/wk group: HR, 1.14; 95% CI, 0.99 to 1.31). In other words, the FLI was a significant determinant of fracture incidence independent of alcohol consumption. However, the remarks of Dr. Lai and colleagues are still relevant because even a small amount of alcohol can lead to fatty liver disease,6 and we agree that it will be important to conduct a new analysis focusing on people who drink little or no alcohol. Further analysis of the data is needed to extract those individuals with negligible alcohol consumption.
As outlined in one of the limitations of the retrospective analysis in the discussion section of our paper, there was no information on whether the fractures were “osteoporotic” or “traumatic,” although we recorded the 10th revision of the International Classification of Disease codes for fractures. Further prospective trials are needed to examine whether a low FLI is associated with a low incidence of “osteoporotic” fracture. As noted in another comment, tailored strategies to reduce effectively fracture risk in patients with NAFLD remain a clinical unmet need.7 The development of such strategies merits further research. Nevertheless, our study clearly demonstrates that Korean adults with a high FLI are predisposed toward fractures, and therefore patients with a high FLI score warrant more attention for the primary prevention of fracture in clinical practice.
No potential conflict of interest relevant to this article was reported.
Gut and Liver 2023; 17(4): 663-664
Published online July 15, 2023 https://doi.org/10.5009/gnl230035
Copyright © Gut and Liver.
Min-Ji Kim1 , Jae-Hyung Roh2 , Jae-Han Jeon1
1Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, and 2Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Daejeon, Korea
Correspondence to:Jae-Han Jeon
ORCID https://orcid.org/0000-0002-9217-968X
E-mail jeonjh@knu.ac.kr
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.
We appreciate Dr. Lai and his colleagues’ interest and comments1 on our article entitled “Relationship between the High Fatty Liver Index and Risk of Fracture,” which was published in the journal
We agree with Dr. Lai and colleagues that studies into the relationship between NAFLD and risk of fracture should only include study subjects with little or no alcohol consumption. At the same time, we would like to emphasize that the definition of NAFLD is a weekly alcohol consumption of less than 210 g in men and 140 g in women, according to the guideline of the European Association for the Study of the Liver3,4 and the Korean Association for the Study of Liver NAFLD guidelines.5 In our study, the alcohol consumptions in the fatty liver index (FLI) quartile groups were Q1: 36.7±83.9, Q2: 60.0±112.9, Q3: 87.1±142.0, and Q4: 139.9±189.6 g/wk,2 indicating that most, if not all, of the subjects drank less alcohol than that stipulated in the NAFLD guidelines. Additionally, we excluded 190,883 patients with known liver disease. Although alcohol consumption is an important factor in the progression of fatty liver disease, the highest mean amount of alcohol consumption in Q4 was less than 140 g/wk. In subgroup analysis of the original article,2 we analyzed the data after dividing the subjects into three groups according to their weekly alcohol consumption (0, 1–139, and ≥140 g). The data showed no significant difference in the hazard ratio between the three groups (alcohol consumption=0 g/wk group: hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.04 to 1.17; alcohol consumption=1–139 g/wk group: HR, 1.13; 95% CI, 1.00 to 1.26; alcohol consumption ≥140 g/wk group: HR, 1.14; 95% CI, 0.99 to 1.31). In other words, the FLI was a significant determinant of fracture incidence independent of alcohol consumption. However, the remarks of Dr. Lai and colleagues are still relevant because even a small amount of alcohol can lead to fatty liver disease,6 and we agree that it will be important to conduct a new analysis focusing on people who drink little or no alcohol. Further analysis of the data is needed to extract those individuals with negligible alcohol consumption.
As outlined in one of the limitations of the retrospective analysis in the discussion section of our paper, there was no information on whether the fractures were “osteoporotic” or “traumatic,” although we recorded the 10th revision of the International Classification of Disease codes for fractures. Further prospective trials are needed to examine whether a low FLI is associated with a low incidence of “osteoporotic” fracture. As noted in another comment, tailored strategies to reduce effectively fracture risk in patients with NAFLD remain a clinical unmet need.7 The development of such strategies merits further research. Nevertheless, our study clearly demonstrates that Korean adults with a high FLI are predisposed toward fractures, and therefore patients with a high FLI score warrant more attention for the primary prevention of fracture in clinical practice.
No potential conflict of interest relevant to this article was reported.
pISSN 1976-2283
eISSN 2005-1212
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
| Yong Chan Lee |
Professor of Medicine Director, Gastrointestinal Research Laboratory Veterans Affairs Medical Center, Univ. California San Francisco San Francisco, USA |
| 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 |
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.
The remaining articles are usually sent to two reviewers. It would be very helpful if you could suggest a selection of reviewers and include their contact details. We may not always use the reviewers you recommend, but suggesting reviewers will make our reviewer database much richer; in the end, everyone will benefit. We reserve the right to return manuscripts in which no reviewers are suggested.
The final responsibility for the decision to accept or reject lies with the editors. In many cases, papers may be rejected despite favorable reviews because of editorial policy or a lack of space. The editor retains the right to determine publication priorities, the style of the paper, and to request, if necessary, that the material submitted be shortened for publication.
