Association between the number of metabolic parameters and vibration controlled transient elastography in patients with lean and non-lean non alcoholic fatty liver disease

Abstract

Background and Aim: Non-alcoholic fatty liver disease(NAFLD) is identified in normal body weight individuals also, termed lean-NAFLD. Lean and non-lean NAFLD patients have higher cardiovascular mortality risks. Liver fibrosis can be assessed using vibration-controlled transient elastography(VCTE) for the early identification of at-risk patients. We tried to evaluate the association between the presence of multiple metabolic syndrome components(MeTSc) as defined by NCEP ATP III criteria with VCTE values in lean and non-lean NAFLD patients. Methods: Cross-sectional observational study including 120 patients of lean NAFLD(BMI<23kg/m2) and 120 non-lean NAFLD(BMI‰¥23 kg/m2). Baseline demographic and clinical data were noted, including measurement of hemogram, liver biochemistry, lipid profile, and HOMA-IR. Liver fibrosis was assessed using VCTE. Data were compared between the two groups. One way ANOVA test was done to identify whether there was a significant association between the number of MeTSc and VCTE values. Results: Among the Lean-NAFLD patients 9.5% had no MeTSc with VCTE 8.5±2.66, 12.5% had 1 MeTSc with VCTE 8.79±2.73, 24.17% had 2 MeTSc with VCTE 7.6±1.97, and 55.85% had 3 MeTSc with VCTE 8.3±2.15. There was no significant difference in VCTE values between these groups(p=0.333). Among non-lean NAFLD patients 0% had no MeTSc, 6.67% had 1 MeTSc with VCTE 6.2±1.39, 12.5% had 2 MeTSc with VCTE 7.4±2.83 and 80.83% had ‰¥3 MeTSc with VCTE 8.18±2.58. The VCTE was higher in patients with higher number of MeTSc(p=0.036). Among lean NAFLD, 40% had significant fibrosis (VCTE >= 7 kpa) and 22% had advanced fibrosis (VCTE>= 9.9kpa). Among non lean NAFLD, 37% had significant fibrosis and 23% had advanced fibrosis. Conclusions: MeTSc are important in determining hepatic fibrosis in patients with non-lean NAFLD. This effect is not seen in patients with lean-NAFLD. Metabolic syndrome is significantly higher in non-lean NAFLD patients than lean NAFLD.