80% of 9/11 first responders present with toxin-associated fatty liver

First responders and those who worked at the site of the September 11 attacks on the World Trade Centers in New York City showed a prevalence of fatty liver at a four times greater occurrence than the general population, according to an expert presenting data during a press conference in advance of Digestive Diseases Week data publication.

“9/11 first responders need to be particularly concerned about fatty liver disease and they must be examined more closely for it,” Mishal Reja, MD, resident physician in internal medicine at Robert Wood Johnson University Hospital, New Brunswick, New Jersey, said during the press conference. “They should be especially careful in managing their diet and related comorbidities because the risk for fatty liver disease is compounded by toxin exposure. As a result, this places first responders at higher risk for NAFLD progression due to cirrhosis, hepatocellular carcinoma and hepatic decomposition. Overall, it makes them vulnerable to increased mortality and morbidity.”

Reja and colleagues looked retrospectively at charts from the World Trade Center Health Program (WTCHP), a government-funded program providing medical benefits to first responders.

In the 243 patients referred for GI symptoms from January 2014 through August 2019, the researchers found a hepatic steatosis index greater than 36 – indicating hepatic steatosis – in 82.6%. In the general population, estimates for prevalence of fatty liver ranges from 24% to 45%, Reja said.

Reja reported that BMI positively correlated with hepatic steatosis (aOR 3.26; 95% CI, 2.24-5.5) but did not differ significantly from the general population.

Patients with steatosis were more likely to have gastritis on endoscopy (68.9% vs. 50%), esophagitis (57.4% vs. 56.2%) and duodenitis (14.9% vs. 12.5%). The most common comorbidities were GERD (70.4%), hypertension (40.3%), diabetes (10.3%), chronic rhinosinusitis (66.7%) and obstructive sleep apnea (52.3%).

“Moving forward, my team and I hope to compare liver ultrasound from 9/11first responders to a control group to gather more detailed information and rate of capital,” Reja said. – by Katrina Altersitz and Monica Jaramillo

Reference: Reja R, et al. Abstract Mo1507. Presented at: Digestive Disease Week; May 2-5, 2020; Chicago (meeting canceled).

Disclosure: Reja reports no relevant financial disclosures.