ABSTRACT
AIM: To determine whether fasting C-peptide is an independent predictor for non-alcoholic fatty liver disease (NAFLD) in United States population. METHODS: Using the National Health and Nutrition Examination Survey (NHANES) 1988-1994, NAFLD participants aged 20 or greater without any other liver diseases were included in this study. Excessive alcohol intake is defined as > 2 drinks per day for males and > 1 drink per day for females. C-peptide and 27 other factors known to be associated with NAFLD (e.g., age, gender, body mass index, waist circumference, race/ethnicity, liver chemistries, and other diabetes tests) were tested in both univariate and multivariate level using logistic regression with a P-value 0.05. RESULTS: Of 18825 participants aged ≥ 20, 3235 participants (n = 3235) met inclusion criteria. There were 23 factors associated with NAFLD by univariate analysis. 9 factors, ranked by the highest change in pseudo R2 , were found to be significant predictors of NAFLD in multivariate model: waist circumference, fasting C-peptide, natural log of alanine aminotransferase (ALT), total protein, being Mexican American, natural log of glycated hemoglobin, triglyceride level, being non-Hispanic white, and ferritin level. CONCLUSION: Together with waist circumference and ALT, fasting C-peptide is among three most important predictors of NAFLD in United States population in the NHANES data set. Further study is needed to validate the clinical utility of fasting C-peptide in diagnosis or monitoring insulin resistance in NAFLD patients.
Subject(s)
C-Peptide/blood , Insulin Resistance , Non-alcoholic Fatty Liver Disease/diagnosis , Adult , Alanine Transaminase/blood , Case-Control Studies , Fasting , Female , Humans , Liver/diagnostic imaging , Liver/pathology , Logistic Models , Male , Middle Aged , Non-alcoholic Fatty Liver Disease/blood , Non-alcoholic Fatty Liver Disease/epidemiology , Non-alcoholic Fatty Liver Disease/pathology , Nutrition Surveys/statistics & numerical data , Prevalence , Risk Factors , Ultrasonography , United States , Waist CircumferenceABSTRACT
BACKGROUND: Based on the location of training programs, internal applicants and local applicants were defined as applicants who attended the same training institution and trained in local areas (i.e., state, division, and region), respectively. While being an internal applicant does influence fellowship matching success for some specialties, gastroenterology fellowship program directors do not rank this consideration in the top half of their priority list. There is no published evidence about the frequency that internal applicants and local applicants match in US gastroenterology training program. AIM: To find the proportion of gastroenterologists who were internal applicants and local applicants during the graduation years 2010-2019. METHODS: Online search in Doximity was conducted to obtain postgraduate training information of gastroenterologists with the graduation years 2010-2019. Programs were classified into nine divisions and four regions per United States Census Bureau. We used confidence level 95% and margin of error 2% to calculate sample size. RESULTS: In total, 1489 physicians (N = 1489) were included. The proportion of internal applicants was 39.56% of the sample size. The proportions of gastroenterologists who attended IM residency programs in the same state, same division, and same region were 53.06, 60.64, and 71.93%, respectively. CONCLUSION: A large proportion of gastroenterologists were either internal applicants or local applicants. Further research is necessary to better understand the reasons behind these trends and whether the bias against external or geographically distant fellowship candidates is intended or unintended, as these data have broad implications for GI fellowship candidate residency program and geography choices.
