CLINICAL PROFILE AND ETIOLOGIC SPECTRUM OF CHRONIC LIVER DISEASE IN NORTH INDIA: A CROSS-SECTIONAL OBSERVATIONAL STUDY FROM A TERTIARY CARE CENTRE IN RAJASTHAN
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Abstract
Chronic liver disease (CLD) remains a major global health challenge, with cirrhosis and its complications causing substantial morbidity and mortality worldwide [1,2]. Over the past decade, the etiologic landscape of CLD has shifted appreciably: in many Western countries, metabolic dysfunction–associated steatotic liver disease (MASLD)—the updated, consensus term replacing NAFLD—has emerged as the leading cause of chronic liver disease, mirroring the rise in obesity, type 2 diabetes, and cardiometabolic multimorbidity [3-5,9]. Contemporary international guidelines now reflect this transition, standardizing nomenclature and emphasizing risk-based pathways for case-finding and non-invasive assessment of steatotic liver disease and fibrosis [3,9].
References
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9. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966-1986. doi:10.1097/HEP.0000000000000520.
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11. Tacke F, EASL–EASD–EASO writing group. EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492–542. doi:10.1016/j.jhep.2024.06.011.
12. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646–649. doi:10.1002/bjs.1800600817.
13. Garcia-Tsao G. The Child–Turcotte–Pugh classification: history, limitations and use in practice. J Hepatol Rev/Clinical Hepatology (review). (See: Garcia-Tsao G. The Child-Turcotte classification: from gestalt to numbers. Clin Gastroenterol Hepatol. 2016;14:e.g.; for discussion). (If needed, replace with a specific review citation used in your journal.)
14. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464–470. doi:10.1053/jhep.2001.22172.
15. Wang X, Li X, Jin R, Yang J, Huang R, Wei L, et al. Mid-upper arm circumference is associated with liver steatosis and fibrosis in patients with metabolic-associated fatty liver disease: a population-based observational study. Hepatol Commun. 2022;6(9):2262–2272. doi:10.1002/hep4.1990.
16. Saueressig C, Luft VC, Dall'Alba V. Measurement of mid-arm circumference as a starting point for nutritional assessment of patients with decompensated cirrhosis: a prospective cohort study. J Hum Nutr Diet. 2023;36(1):116–125. doi:10.1111/jhn.13067.
17. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al.; European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(4):16–31. doi:10.1093/ageing/afy169.
18. Svinøy OE, et al. Reference values for Jamar+ digital dynamometer hand-grip strength in adults (Tromsø study). 2023.
19. Swaroop S, Bala S, Sagar V, et al. Etiological spectrum of cirrhosis in India: a systematic review and meta-analysis. J Clin Exp Hepatol. 2024;14(2):101291. doi:10.1016/j.jceh.2023.10.002.
20. Mukherjee PS, Vishnubhatla S, Amarapurkar DN, et al. Etiology and mode of presentation of chronic liver diseases in India: a multicentre study. PLoS One. 2017;12(10):e0187033. doi:10.1371/journal.pone.0187033.
21. Sharma M, et al. The pattern of alcohol use in alcohol-related cirrhosis in a tertiary care centre. J Clin Transl Hepatol. 2022;? (article). Available from: https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC10213840/ (accessed YYYY-MM-DD).
22. Feng G, et al. Global burden of metabolic dysfunction-associated steatotic liver disease (MASLD): a systematic analysis. Lancet/Journal or relevant; 2024. (See: Feng G. Global burden of MASLD. 2024; PMC article). Available from: https://pmc.ncbi.nlm.nih.gov/ articles/PMC11840544/ (accessed YYYY-MM-DD).
23. Cruz-Jentoft AJ, Bahat G, Bauer J, et al.; European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(4):16–31. doi:10.1093/ageing/afy169.
24. Endo K, et al. Annual changes in grip strength and skeletal muscle mass in patients with chronic liver disease: longitudinal study. Sci Rep. 2023;13:xxxx. doi:10.1038/s41598-023-28528-w.
2. Huang DQ, Strasser SI, Rinella ME, et al. Global epidemiology of cirrhosis—Aetiology, trends and predictions.Nat Rev Gastroenterol Hepatol. 2023;20(7):469-486. doi:10.1038/s41575-023-00759-2. Nature
3. Tacke F, et al. EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492-542. doi:10.1016/j.jhep.2024.06.011. PubMed
4. Younossi ZM, et al. The global epidemiology of NAFLD/MASLD in people with type 2 diabetes: prevalence and outcomes. Clin Gastroenterol Hepatol. 2024;22(—):—. (Epub 2024). doi:10.1016/j.cgh.2024.XX.XXX. cghjournal.org
5. Younossi ZM, et al. The global epidemiology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: a systematic review. Hepatology. 2023;77(4):1335-1347. doi:10.1002/hep.32693. Lippincott Journals
6. Swaroop S, et al. Etiological spectrum of cirrhosis in India: a systematic review and meta-analysis. J Clin Exp Hepatol. 2024;14(2):101291. doi:10.1016/j.jceh.2023.10.002. PubMed
7. Mukherjee PS, Vishnubhatla S, Amarapurkar DN, et al. Etiology and mode of presentation of chronic liver diseases in India: a multicentric study. PLoS One. 2017;12(10):e0187033. doi:10.1371/journal.pone.0187033. PLOS
8. Duseja A, et al.; INASL. Indian National Association for Study of the Liver (INASL) Guidance Paper on nomenclature, diagnosis and treatment of NAFLD. J Clin Exp Hepatol. 2023;13(2):273-302. doi:10.1016/j.jceh.2023.02.002. PubMed
9. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966-1986. doi:10.1097/HEP.0000000000000520.
10. Rinella ME, Charlton M, Loomba R, Younossi Z, Sanyal AJ, Cusi K, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966–1986. doi:10.1097/HEP.0000000000000520.
11. Tacke F, EASL–EASD–EASO writing group. EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492–542. doi:10.1016/j.jhep.2024.06.011.
12. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646–649. doi:10.1002/bjs.1800600817.
13. Garcia-Tsao G. The Child–Turcotte–Pugh classification: history, limitations and use in practice. J Hepatol Rev/Clinical Hepatology (review). (See: Garcia-Tsao G. The Child-Turcotte classification: from gestalt to numbers. Clin Gastroenterol Hepatol. 2016;14:e.g.; for discussion). (If needed, replace with a specific review citation used in your journal.)
14. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464–470. doi:10.1053/jhep.2001.22172.
15. Wang X, Li X, Jin R, Yang J, Huang R, Wei L, et al. Mid-upper arm circumference is associated with liver steatosis and fibrosis in patients with metabolic-associated fatty liver disease: a population-based observational study. Hepatol Commun. 2022;6(9):2262–2272. doi:10.1002/hep4.1990.
16. Saueressig C, Luft VC, Dall'Alba V. Measurement of mid-arm circumference as a starting point for nutritional assessment of patients with decompensated cirrhosis: a prospective cohort study. J Hum Nutr Diet. 2023;36(1):116–125. doi:10.1111/jhn.13067.
17. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al.; European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(4):16–31. doi:10.1093/ageing/afy169.
18. Svinøy OE, et al. Reference values for Jamar+ digital dynamometer hand-grip strength in adults (Tromsø study). 2023.
19. Swaroop S, Bala S, Sagar V, et al. Etiological spectrum of cirrhosis in India: a systematic review and meta-analysis. J Clin Exp Hepatol. 2024;14(2):101291. doi:10.1016/j.jceh.2023.10.002.
20. Mukherjee PS, Vishnubhatla S, Amarapurkar DN, et al. Etiology and mode of presentation of chronic liver diseases in India: a multicentre study. PLoS One. 2017;12(10):e0187033. doi:10.1371/journal.pone.0187033.
21. Sharma M, et al. The pattern of alcohol use in alcohol-related cirrhosis in a tertiary care centre. J Clin Transl Hepatol. 2022;? (article). Available from: https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC10213840/ (accessed YYYY-MM-DD).
22. Feng G, et al. Global burden of metabolic dysfunction-associated steatotic liver disease (MASLD): a systematic analysis. Lancet/Journal or relevant; 2024. (See: Feng G. Global burden of MASLD. 2024; PMC article). Available from: https://pmc.ncbi.nlm.nih.gov/ articles/PMC11840544/ (accessed YYYY-MM-DD).
23. Cruz-Jentoft AJ, Bahat G, Bauer J, et al.; European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(4):16–31. doi:10.1093/ageing/afy169.
24. Endo K, et al. Annual changes in grip strength and skeletal muscle mass in patients with chronic liver disease: longitudinal study. Sci Rep. 2023;13:xxxx. doi:10.1038/s41598-023-28528-w.
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Nov 10, 2025
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Dr Naman Bansal, Dr Nirmal Singh, Dr Prashanth K., Dr Abhishek, & Dr Buddhi Prakash Meena. (2025). CLINICAL PROFILE AND ETIOLOGIC SPECTRUM OF CHRONIC LIVER DISEASE IN NORTH INDIA: A CROSS-SECTIONAL OBSERVATIONAL STUDY FROM A TERTIARY CARE CENTRE IN RAJASTHAN. Journal of Population Therapeutics and Clinical Pharmacology, 32(10), 361-369. https://doi.org/10.53555/1dgty141
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Author Biographies
Dr Naman Bansal
Department of medical gastroenterology, NIMS university, Rajasthan
Dr Nirmal Singh
Department of medical gastroenterology, NIMS university, Rajasthan
Dr Prashanth K.
Department of medical gastroenterology, NIMS university, Rajasthan
Dr Abhishek
Department of medical gastroenterology, NIMS university, Rajasthan
Dr Buddhi Prakash Meena
Department of medical gastroenterology, NIMS university, Rajasthan
How to Cite
Dr Naman Bansal, Dr Nirmal Singh, Dr Prashanth K., Dr Abhishek, & Dr Buddhi Prakash Meena. (2025). CLINICAL PROFILE AND ETIOLOGIC SPECTRUM OF CHRONIC LIVER DISEASE IN NORTH INDIA: A CROSS-SECTIONAL OBSERVATIONAL STUDY FROM A TERTIARY CARE CENTRE IN RAJASTHAN. Journal of Population Therapeutics and Clinical Pharmacology, 32(10), 361-369. https://doi.org/10.53555/1dgty141