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Background With its increasing incidence, nonalcoholic fatty liver disease ( NAFLD) is of particular concern in the Veterans Health Administration ( VHA). Aims To evaluate risk factors for advanced fibrosis in biopsy-proven NAFLD in the VHA, to identify patients at risk for adverse outcomes. Methods In randomly selected cases from VHA databases (2005-2015), we performed a retrospective case-control study in adults with biopsy-defined NAFLD or normal liver. Results Of 2091 patients reviewed, 399 met inclusion criteria. Normal controls (n = 65) had normal liver function. The four NAFLD cohorts included: NAFL steatosis (n = 76), nonalcoholic steatohepatitis ( NASH) without fibrosis (n = 68), NAFLD/ NASH stage 1-3 fibrosis (n = 82), and NAFLD/ NASH cirrhosis (n = 70). NAFLD with hepatocellular carcinoma ( HCC) was separately identified (n = 38). Most patients were older White men. NAFLD patients with any fibrosis were on average severely obese ( BMI>35 kg/m2). Diabetes (54.4%-79.6%) and hypertension (85.8%-100%) were more common in NAFLD with fibrosis or HCC. Across NAFLD, 12.3%-19.5% were enrolled in diet/exercise programs and 0%-2.6% had bariatric surgery. Hispanics exhibited higher rates of NASH (20.6%), while Blacks had low NAFLD rates (1.4%-11.8%), particularly NAFLD cirrhosis and HCC (1.4%-2.6%). Diabetes ( OR 11.8, P < .001) and BMI ( OR 1.4, P < .001) were the most significant predictors of advanced fibrosis. Conclusions In the VHA, diabetes and severe obesity increased risk for advanced fibrosis in NAFLD. Of these patients, only a small proportion (~20%) had enrolled in diet/exercise programs or had bariatric surgery (~2%). These results suggest that providers should focus/tailor interventions to improve outcomes, particularly in those with diabetes and severe obesity. [ABSTRACT FROM AUTHOR]

Background: Gulf War Illness (GWI) is a chronic, multi‐symptom disorder affecting 25%–32% of Gulf War veterans. Veterans with GWI disproportionately suffer from gastrointestinal (GI) disorders. Given the increasing evidence supporting a gut‐brain axis, we explore the relationship between post‐traumatic stress disorder (PTSD), GWI, and self‐reported GI disorders among GW veterans. Methods: Veterans from the Gulf War Era Cohort and Biorepository responded to a mail‐based survey (N = 1058). They were stratified by GWI (Centers for Disease Control definition) and PTSD status. This yielded three groups: GWI−, GWI+/PTSD−, and GWI+/PTSD+. Multivariable logistic regression adjusting for demographic and military characteristics examined associations between GWI/PTSD groups and GI disorders. Results were expressed as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). Key Results: The most frequently reported GI disorders were irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and colon polyps (CP). The GWI+/PTSD+ group had a higher odds of these disorders than the GWI+/PTSD− group (aORIBS = 3.12, 95% CI: 1.93–5.05; aORGERD = 2.04, 95% CI: 1.44–2.90; aORCP = 1.85, 95% CI: 1.23–2.80), which had a higher odds of these disorders than the GWI− group (aORIBS = 4.38, 95% CI: 1.55–12.36; aORGERD = 2.51 95% CI: 1.63–3.87; aORCP = 2.57, 95% CI: 1.53–4.32). Conclusions & Inferences: GW veterans with GWI and PTSD have significantly higher odds of specific self‐reported GI disorders than the other groups. Given the known bidirectional influences of the gut and brain, these veterans may benefit from a holistic healthcare approach that considers biopsychosocial contributors to the assessment and management of disease. [ABSTRACT FROM AUTHOR]