Metabolic diseases

Metabolic (dysfunction)-associated fatty liver disease (MAFLD) or metabolic (dysfunction)-associated steatotic liver disease (MASLD) is the most common and fastest growing cause of chronic liver disease worldwide. There has been a substantial increase in the epidemiological research regarding MASLD/MAFLD originating from Australia since 2020. This narrative review summarises these pivotal epidemiological studies investigating the disease prevalence, natural history, prognostication and management of this condition. The Australian literature demonstrates the prevalence to be between one-third and two-fifths of adults affected, depending on nomenclature, with a heightened risk of cardiovascular disease irrespective of terminology. Current local data support guideline-based disease staging with non-invasive tests of fibrosis and the management continues to centre on diet and lifestyle interventions, with directed therapy on the horizon.

Karl Vaz, Daniel Clayton-Chubb, William W. Kemp, Stuart K. Roberts, Ammar Majeed

The program could be integrated into routine antenatal care to reduce the risk of preterm birth in Australia

Karen P Best · Celine Northcott · Lucy A Simmonds · Philippa Middleton · Lisa N Yelland · Vanessa Moffa · Khoa Lam · Penelope Coates · Cornelia Späth · Carol WK Siu · Karen Glover · Rhiannon Smith · Robert Gibson · Maria Makrides

Targeted public health measures for particular patient subgroups are required to save lives among people with cirrhosis

Vikas Bhasker · Jessica R Fong · Paul J Clark · Gunter F Hartel · Richard Skoien · James O’Beirne · Elizabeth E Powell · Patricia C Valery

In recognition of the increasing burden of metabolic dysfunction-associated fatty liver disease (MAFLD) in Australia, and the lack of clear guidelines for general practitioners, this consensus statement summary presents 21 recommendations on the assessment and monitoring of MAFLD in adult patients in primary care

Leon A Adams · William W Kemp · Kate R Muller · Elizabeth E Powell · Stuart K Roberts · Luis Calzadilla Bertot · Stephanie Best · Gary Deed · Jon D Emery · Samantha L Hocking · Graham R Jones · John S Lubel · Sinead Sheils · Stephen M Twigg · Gerald F Watts · Jacob George

A 70-year-old woman presented to the emergency department with symptomatic hyperkalaemia after excessive ingestion of potassium bitartrate to relieve constipation

Daniel Yee Lee Ng · Laksmi Govindasamy · Andrew Hughes · Hwee Min Lee

Aboriginal community-controlled health organisations holistically take the social determinants of health into account in service and program delivery

Rona Macniven · Karla J Canuto

Culturally acceptable strategies for improving risk factors could reduce cardiometabolic disease in remote Aboriginal and Torres Strait Islander communities

Hasthi UW Dissanayake · George Gurruwiwi · J Dhurrkay · Josh C Tynan · Sabine Braat · Benjamin Harrap · Tim Trudgen · Sarah Hanieh · Bronwyn Clark · Michaela Spencer · Michael Christie · Emma Tonkin · Emily Armstrong · Leonard C Harrison · John M Wentworth · Julie K Brimblecombe · Beverley‐Ann Biggs

A 65-year-old man was referred to a private dermatologist for diagnosis and management of a hyperkeratotic, scaly, pruritic eruption affecting the trunk and extremities, which had been worsening over 12 months

Matthew J Verheyden · Vicki Howard · Monisha Gupta

Socio-economic disadvantage increases the risk of vitamin C deficiency and is a significant public health problem

Puja Bhattacharyya · Kathrin Schemann · San San Min · David R Sullivan · Stephen J Fuller

Multidisciplinary models of care including dietary therapy are needed in Australia

Jessica Fitzpatrick · Sarah L Melton · Rebecca E Burgell

Joshua M Inglis · Ganessan Kichenadasse · Arduino A Mangoni

There is emerging evidence for increased person-centred care and treatment adaptation

Phillipa J Hay · Rebekah Rankin · Lucie Ramjan · Janet Conti

A 40-year-old man was referred to the neuromuscular clinic with generalised fasciculations

Dhayalen Krishnan · Matthew C Kiernan

To the Editor: Paradoxically, both vitamin B6 deficiency and excess are associated with peripheral neuropathy. Increasingly, patients are presenting with peripheral neuropathy associated with elevated vitamin B6 whole blood levels, as previously presented by our laboratory.1 With a societal push towards wellness, there has been a greater uptake of over‐the‐counter vitamins in recent years. Magnesium is taken by patients for muscle, nerve and digestive issues, as well as for stress, anxiety and overall wellness. For some of these listed indications, the evidence is dubious. Vitamin B6 (as pyridoxine hydrochloride) is common among magnesium supplements based on the theory that the cellular uptake of magnesium is enhanced.2 These supplements are readily available in pharmacies, supermarkets and online, and contain up to 60mg of vitamin B6 per tablet. When purchasing magnesium supplements, patients may be unaware that they are also getting vitamin B6 and the quantity included could be hazardous to health. A patient taking two magnesium tablets per day could be unintentionally consuming 120mg of vitamin B6, now considered a large dose. This is far greater than the recommended dietary intake of vitamin B6 for adults in Australia and New Zealand of 1.3–2.0mg/day with a maximum of 50mg/day.3 The pharmacokinetics of pyridoxine hydrochloride are complex. Despite being water soluble, it has a half‐life of up to 30 days. Repetitive small doses taken over a period of months can accumulate, resulting in high blood concentrations. Vitamin B6 is associated with peripheral neuropathy when whole blood levels exceed 250nmol/L.4 Our laboratory recently presented a study showing that about 39% of our patients had elevated vitamin B6 whole blood levels (>190mol/L, the upper limit of our reference interval). The study included data from 88655 samples.1 A recent regulatory change from the Therapeutic Goods Administration mandated that products containing vitamin B6 in daily doses above 10mg now require a label warning.5 This previously applied to products containing over 50mg per daily dose. The Therapeutic Goods Administration has also reduced the maximum permitted daily dose from 200mg to 100mg for adults. It also noted cases where peripheral neuropathy developed in patients taking less than 50mg daily.5 This change applies to products produced after 1 March 2023 and therefore does not apply to products purchased before this date. In addition to being present in magnesium supplements, vitamin B6 (as pyridoxine hydrochloride) is contained in many multivitamins and energy drinks. Community awareness is key.

Gemma M Daley · David Kanowski · Lee Price

Five medications are currently indicated for obesity management in Australia, all of which have beneficial effects on obesity-related complications

Rosalind Walmsley · Priya Sumithran