assesment 3 new

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6. Aside from the experimental intervention, were the groups treated equally?

Yes

Evidence: Both groups were treated equally apart from their medical conditions. So bias was reduced by treating them equally.

Critical appraisal questions

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7. Have the authors taken account of the potential confounding factors in the design and/or in their analysis?

Unclear

Evidence: The confounding factors related to this study are unclear. Although the age, gender, duration of alcohol consumption was taken into account. PLEASE CHECK THIS LINE ABOUT CPNFOUNDING FACTORS BECAUSE WHEN YOU ADD HERE AGE AND GANDER THEN WHY ITS UNCLEAR FACTOR

Critical appraisal questions

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8. How large was the treatment effect?

Unclear

Evidence: The treatment effect is unclear because this study mainly focuses on alcohol consumption and liver diseases. So the researchers focused on the duration of alcohol consumption instead of the duration of treatment.

Critical appraisal questions

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9. How precise was the estimate of the treatment effect?

Unclear

Evidence: The treatment is unclear in this study because the main focus was on the disease in this study instead of the treatment of disease.

Critical appraisal questions

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10. Do you believe the results?

Yes

Evidence: Yes, I believe in the results because the results have been obtained by applying statistical analysis, and patients were selected after conducting the proper interview and medical examination.

Critical appraisal questions

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11. Can the results be applied to the local population?

Yes

Evidence: The results can be applied to the local population as well because the rate of alcohol consumption has been increased to a great extent and it has also increased the prevalence of alcoholic liver diseases including alcoholic fatty liver.

Critical appraisal questions

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12. Do the results of this study fit with other available evidence?

Yes

Evidence: There are many studies in literature which support this study and still many studies are in progress to know about the effect and association of alcohol on liver diseases. Valenti et al. 2007 has also conducted this type of study. (Corrao et a. 1993)

Reference

Corrao, G., Arico, S., Lepore, A. R., Valenti, M., Torchio, P., Galatola, G., ... & Di Orio, F. (1993). Amount and duration of alcohol intake as risk factors of symptomatic liver cirrhosis: a case—control study. Journal of clinical epidemiology, 46(7), 601-607.

Table 3 Cohort study:

“Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups- the multi-ethnic cohort”

Critical appraisal questions

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1. Did the study address a clearly focused issue?

Yes

Evidence:SAME WORDS OF ANOTHER ASSISGNMENT The study addressed the clearly focused issue because liver diseases have become major sources of morbidity and mortality in different states of America. WHERE IS THE RATE OF MORBIDITY AND MORTALIOTY RATE

Critical appraisal questions

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2. Was the cohort recruited in an acceptable way?

Yes

Evidence: the cohorts were recruited in acceptable way because they were selected after getting their complete information on questionnaire. Their personal information and previous medical history was also determined.

Critical appraisal questions

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3. Was the exposure accurately measured to minimise bias?

Yes

Evidence: the exposure was accurately measured to minimize the bias. The patient’s history, gender, medical history and duration of consumption of alcohol was taken into count before starting the study. HOW BIAS MINIMISE here

Critical appraisal questions

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4. Was the outcome accurately measured to minimise bias?

Yes

Evidence: The outcome was accurately measured to minimize the bias and the data of patients was collected from the year 1999 to 2012. Biases were then minimized by doing accurate measurement and by proper diagnosis of disease. ADD SUPPORTING EVIDENCE TO THIS LINE

Critical appraisal questions

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5(a) Have the authors identified all important confounding factors?

Yes

Evidence: The authors identified all important confounding factors such as gender, medial history, body mass index and history of alcohol consumption.

Critical appraisal questions

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5(b) Have they taken account of the confounding factors in the design and/or analysis?

Yes

Evidence: The confounding factors were taken into account by applying MEC study design. COULD YOU PLEASE ELABORATE THIS ONE AND WHAT IS MEC STUDY?

Critical appraisal questions

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6(a) Was the follow up of subjects complete enough?

Yes

Evidence: DON’T USE SAME WORDS OF ANOTHER ASSIGNMENT The follow up of the subjects is complete enough and its duration lasts for 1993 to 1996 and data of liver patients was collected between 1999 to 2012. Patients were selected after taking their information on questionnaire.

Critical appraisal questions

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6(b) Was the follow up of subjects long enough?

Yes

Evidence: The duration of follow up is long and the duration of the study is around 3 years. This study was conducted by taking the data of 1993 to 1996 and data of liver patients was obtained from 1999 to 2012.

REPITITION

Critical appraisal questions

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7. What are the results of this study?

Yes

Evidence: it has been found that there were 5783 patients who were suffering from liver disease. This study was conducted on different nations and there were 24.9% Americans in which liver diseases were found and the most common cause was alcohol.

Critical appraisal questions

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8. How precise are the results?

Yes

Evidence: The results are precise because results have been obtained by applying statistical analysis. SAS analysis was applied to obtain its results and P values were obtained from both sides.

Critical appraisal questions

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9. Do you believe the results?

Yes

Evidence: Yes, I believe on results because the results have been obtained after applying statistical analysis and extensive study has been performed to obtain its results.

NEED MORE INFORMATION TO SUPPORT THIS LINE

Critical appraisal questions

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10. Can the results be applied to the local population?

Yes

Evidence: The results can partially be applied to local population because this study was conducted on different population such as Americans, Africans etc. So the results which have been obtained on American population can only be applied to local population.

Critical appraisal questions

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11. Do the results of this study fit with other available evidence?

Yes

Evidence: The results are considered to be supported by other studies in literature. Wong et. al. (2015) also found out the association and prevalence of alcoholic fatty liver disease in United States.

Critical appraisal questions

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12.What are the implications of this study for practice?

Yes

Evidence: Alcohol consumption has become quite common among American population and prevalence of fatty liver disease is also increasing day by day. So this study can be used to raise awareness among American population and to raise awareness of alcohol consumption with fatty liver. (Setiawan, 2016)

Reference

Setiawan, V. W., Stram, D. O., Porcel, J., Lu, S. C., Le Marchand, L., & Noureddin, M. (2016). Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: the multiethnic cohort. Hepatology, 64(6), 1969-1977.

Discussion:

Article 1: Cross-sectional study authored by Wong et al. 2019 (Cross-sectional study authored by Alam et al)

In this cross-sectional study, different diseases were considered in the American population such as alcoholic fatty liver disease, alcoholic hepatitis, cirrhosis, complications caused by cirrhosis (Wong, 2019). This study was conducted by taking the data of patients between 2001- 2016. The study population was selected after taking proper interviews and medical examinations. The liver enzyme levels, gender, previous medical history, and duration of alcohol consumption were taken into account before conducting this study (Wong, 2019)

This study was conducted on the study population after taking interviews and medical examinations on persons. While examining patients, their alcohol consumption habit was taken into account. Hepatitis B and hepatitis C patients were excluded from this study (Wong, 2019).

Then statistical analysis was applied to get its results. Multivariable logistic regression was applied to obtain results and linear trends in prevalence were also analyzed. Results showed that there were about 4.3% of persons who were identified with AFLD. Its prevalence remained stable till 2016 with stage 1. But the prevalence of AFLD increased by 0.6% during this tenure (Wong, 2019).

Article 2: Case-Control study authored by Corrao et al. 1993 ( Case control study authored by Gupta et al)

This case-control study indicates the prevalence of alcoholic liver diseases. This study was mainly conducted in the hospital so 320 patients were selected after the interview and medical examination (Corrao, 1993). Then 320 pairs were matched with these patients to conduct a case-control study. Their lifetime alcohol consumption was also considered with it.

Then the results were obtained by statistical analysis. Conditional logistic regression was applied to obtain results. And it increased from 1 to 4.2 for LDAI of 25 g or more. This study was conducted on patients who were consuming alcohol from 10 years to 30 years (Biselli, 2010).

The results suggested that there are dose-dependent relationships between liver disease and consumption of alcohol. And it gives rise to various diseases such as alcoholic fatty liver, alcoholic cirrhosis.

Article 3: Cohort study authored by Setiawan et al. 2016 Cohort Study Authored by Jayalekshmi et al

This cohort study aims to analyze the epidemiology of alcoholic liver diseases as liver diseases and cirrhosis have become major sources of mortality and morbidity in the United States. It has been studied that in 2013 more than 36000 deaths occurred due to liver diseases in the United States. The untreated alcoholic fatty liver led to chronic liver disease which caused almost 66,000 deaths in United States in a year. The prevalence of the liver disease has been increased from 1988 to 2008 (Setiawan, 2016).

This prospective cohort study was performed on more than 215,000 males and females. This study was conducted on patients of age 45- 75 years old. The CLD and cirrhosis were identified on the basis of inpatient and outpatient history. Their alcohol-related disorders were also considered for this study such as alcohol consumption rate, alcoholic neuropathy (Stepanova, 2013).

Then statistical analysis was applied to obtain its results. The whole analysis was performed by using the SAS system. This study was performed on 5,783 persons, these patients were suffering from chronic liver disease followed by alcoholic fatty liver. Some of these patients were suffering from cirrhosis and some had no cirrhosis (Setiawan, 2016). About 51.7% of patients had NAFLD, 8.6% of patients had ALD. The persons who were at the age of 70 years or more were at high risk of developing of chronic liver disease.

Discussion on bias, confounding factors and chances

Bias is a systematic error and it should be minimized by proper selection of cases and proper measurement. Because any error or biases can lead to false results. Research studies also depend on confounding factors sometimes, it arises when risk factors and outcomes both are dependent on or associated with a third variable (White, 2012). To reduce confounding or to avoid it, those controls should be selected who are independent of exposure. It can also be reduced by randomization and matching. It can also be adjusted by applying different statistical analysis such as multivariable analysis and stratified analysis. Stratification is the best technique and most of the researchers use this technique. Chance is also an error that can occur during research but it is a sample and it can be minimized by recruiting a large sample (Zakhari, 2016).

Conclusion:

This paper concluded that alcohol is associated with many liver diseases such as alcoholic fatty liver, chronic liver disease etc. if it is not treated then it may lead to chronic liver disease or cirrhosis which are untreatable in most of the cases (Zakhari, 2016). The widespread of this alcoholic fatty liver diseasea is increasing day by day in the United States and females are at high risk of this liver disease. The development of alcoholic fatty liver is dose-dependent and duration-dependent of alcohol.

Reference

Wong, T. (2019, May 7). Prevalence of Alcoholic Fatty Liver Disease Among Adults in the United States, 2001-2016. Retrieved from https://jamanetwork.com/journals/jama/fullarticle/2732559

Corrao, G., Arico, S., Lepore, A. R., Valenti, M., Torchio, P., Galatola, G., ... & Di Orio, F. (1993). Amount and duration of alcohol intake as risk factors of symptomatic liver cirrhosis: a case—control study. Journal of clinical epidemiology, 46(7), 601-607.

Setiawan, V. W., Stram, D. O., Porcel, J., Lu, S. C., Marchand, L. L., & Noureddin, M. (2016, July 17). Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: The multiethnic cohort. Retrieved from https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep.28677

Moriya, A., Iwasaki, Y., Ohguchi, S., Kayashima, E., Mitsumune, T., Taniguchi, H., … Yamamoto, K. (2014, November 27). Roles of alcohol consumption in fatty liver: A longitudinal study. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0168827814008745

White, D. L., Kanwal, F., & El–Serag, H. B. (2012, October 4). Association Between Nonalcoholic Fatty Liver Disease and Risk for Hepatocellular Cancer, Based on Systematic Review. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1542356512011536

Sayiner, M., Koenig, A., Henry, L., & Younossi, Z. M. (2016). Epidemiology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis in the United States and the rest of the world. Clinics in liver disease, 20(2), 205-214.

Zakhari, S., Radaeva, S., & Vasiliou, V. (2016, January 1). Hepatic and Extrahepatic Malignancies in Alcoholic Liver Disease. Retrieved from https://link.springer.com/chapter/10.1007/978-3-319-20538-0_13

Stepanova, M., Rafiq, N., Makhlouf, H., Agrawal, R., Kaur, I., Younoszai, Z., ... & Younossi, Z. M. (2013). Predictors of all-cause mortality and liver-related mortality in patients with non-alcoholic fatty liver disease (NAFLD). Digestive diseases and sciences, 58(10), 3017-3023.