P0723 - Adenoma Detection in NAFLD Patients Undergoing Screening Colonoscopy in an Urban Medical Center

Salina Faidhalla, MD¹, Daniel DeNeve, MD², Anam Ansari, DO³, Danielle Rangel Paradela, BSc⁴, Yechiel Mor, MD³, Jing Wang, MD³, Neel H. Patel, DO³, Sarvani Surapaneni, MD³, Zaid Kaloti, MD⁵, Mahvish Khalid, MD³, Paul Naylor, PhD⁴, Milton G. Mutchnick, MD, FACG^4
1DMC/WSU, Wauwatosa, WI; ²WSU DMC, Detroit, MI; ³Wayne State University, Detroit Medical Center, Detroit, MI; ⁴Wayne State University School of Medicine, Detroit, MI; ⁵Wayne State University School of Medicine, LaSalle, ON, Canada

Introduction: We have reported racial disparities between African Americans (AA) and Non-AA patients with respect to BMI and adenoma risk (increases with BMI in Non-AA and decreases in AA). In contrast, Non-Alcoholic Fatty Liver Disease (NAFLD) is lower in AA patients as compared to non-AA with no consensus for adenoma risk in non-Asian populations. Given the lack of studies with significant AA populations, the objective of this study was to evaluate adenoma risk as a function of NAFLD in AA vs non-AA patients undergoing screening colonoscopies.

Methods: After excluding individuals with viral hepatitis and high alcohol consumption, there were 476 screening colonoscopies performed by Academic Gastroenterologists in the last 6 months of 2017. NAFLD was defined by fat reported on imaging, the presence of metabolic syndrome (MetS) or by the combination of both (NAFLD-Overall). MetS was defined as meeting a minimum of 3 out of 5 assessments: BMI >30, Diabetes, Hypertension, Triglycerides > 150 and Non-HDL > 130. NAFLD Fibrosis risk score was calculated as: 1.675 + (0.037*age [years]) + (0.094*BMI [kg/m²]) + (1.13*IFG/diabetes [yes = 1, no = 0]) + (0.99*AST/ALT ratio) – (0.013*platelet count [×10⁹/L]) – (0.66*albumin [g/dl]).

Results: Most patients were AA (88%), the age range was 46-73 and the adenoma detection rate (ADR) was: AA-Male 50%, AA-Female 36%, Non-AA-M 38%, Non-AA-F 35%, p< 0.04). NAFLD as defined by MetS was present in 32%, by imaging in 31% and as NAFLD-Overall in 34% patients. There was no statistically significant difference in the adenoma detection among the three groups either for the total population or by race (Table 1). NAFLD Overall patients had a higher NAFLD Fibrosis risk score than Non-NAFLD-Overall individuals (-0.76 vs -1.8 p=0.0001) due primarily to the large number of AA patients (Figure 1). This was also true for imaging defined NAFLD (-0.33 vs -1.62, p= 0.009) and MetS defined NAFLD. (AA -0.71 vs -1.75 with p= 0.0001; Non-AA -0.84 vs -1.73 with p= 0.047).

Discussion: NAFLD was present in 1/3 of the predominately AA population. AA and Non-AA patients with NAFLD were not more likely to have an adenoma than non-NAFLD individuals. This observation is in the context of two previous studies which were divergent in their observations. Patients with NAFLD were, however, more likely to have an increased risk of liver disease based on an increased in NAFLD fibrosis score as compared to non-NAFLD individuals.


Figure: NAFLD Fibrosis Risk Score and Race

	Total			AA			non-AA
	NAFLD	No-NAFLD	P*	NAFLD	No-NAFLD	P	NAFLD	No-NAFLD	P
NAFLD-Overall	66/162* * = 41%	131/314 = 42%	0.84	58/143 = 41%	119/278 = 43%	0.66	8/19 = 42%	12/36 = 33%	0.52
NAFLD-MetS	54/143 = 38%	142/327 = 43%	0.38	48/137 = 38%	128/288 = 44%	0.34	6/16 = 38%	14/39 = 36%	0.91
NAFLD-Imaging	12/23 = 52%	26/51 = 49%	0.80	10/18 = 56%	22/47 = 47%	0.53	2/5 = 56%	3/4 = 75%	0.29
*significance in Pearson Chi-Square Analysis ** number with adenoma/total colonoscopies

Table: Table 1 Adenoma Detection by Race in NAFLD Compared to Non-NAFLD Individuals


Disclosures:
Salina Faidhalla indicated no relevant financial relationships.
Daniel DeNeve indicated no relevant financial relationships.
Anam Ansari indicated no relevant financial relationships.
Danielle Rangel Paradela indicated no relevant financial relationships.
Yechiel Mor indicated no relevant financial relationships.
Jing Wang indicated no relevant financial relationships.
Neel Patel indicated no relevant financial relationships.
Sarvani Surapaneni indicated no relevant financial relationships.
Zaid Kaloti indicated no relevant financial relationships.
Mahvish Khalid indicated no relevant financial relationships.
Paul Naylor indicated no relevant financial relationships.
Milton Mutchnick: Abbvie – Speaker's Bureau. CLDF – Advisory Committee/Board Member. Gilead – Speaker's Bureau. Intercept – Speaker's Bureau.


Salina Faidhalla, MD¹, Daniel DeNeve, MD², Anam Ansari, DO³, Danielle Rangel Paradela, BSc⁴, Yechiel Mor, MD³, Jing Wang, MD³, Neel H. Patel, DO³, Sarvani Surapaneni, MD³, Zaid Kaloti, MD⁵, Mahvish Khalid, MD³, Paul Naylor, PhD⁴, Milton G. Mutchnick, MD, FACG⁴. P0723 - Adenoma Detection in NAFLD Patients Undergoing Screening Colonoscopy in an Urban Medical Center, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.