Discrimination of individuals in a general population at high-risk for alcoholic and non-alcoholic fatty liver disease based on liver stiffness: a cross section study

Kuniaki Sadaoka,Masaru Baba,Hideaki Bandou,Ken Furuya,Kenji Kasai

doi:10.1186/1471-230x-11-70

Abstract

BackgroundFactors associated with liver stiffness (LS) are unknown and normal reference values for LS have not been established. Individuals at high risk for alcoholic (ALD) and non-alcoholic fatty (NAFLD) liver disease need to be non-invasively discriminated during routine health checks. Factors related to LS measured using a FibroScan and normal reference values for LS are presented in this report.MethodsWe measured LS using a FibroScan in 416 consecutive individuals who presented for routine medical checks. We also investigated the relationship between LS and age, body mass index (BMI), liver function (LF), alcohol consumption, and fatty liver determined by ultrasonography. We identified individuals at high-risk for ALD and NAFLD as having a higher LS value than the normal upper limit detected in 171 healthy controls.ResultsThe LS value for all individuals was 4.7 +/- 1.5 kPa (mean +/- SD) and LS significantly and positively correlated with BMI and LF test results. The LS was significantly higher among individuals with, than without fatty liver. Liver stiffness in the 171 healthy controls was 4.3 +/- 0.81 kPa and the upper limit of LS in the normal controls was 5.9 kPa. We found that 60 (14.3%) of 416 study participants had abnormal LS. The proportion of individuals whose LS values exceeded the normal upper limit was over five-fold higher among those with, than without fatty liver accompanied by abnormal LF test results.ConclusionsLiver stiffness could be used to non-invasively monitor the progression of chronic liver diseases and to discriminate individuals at high risk for ALD and NAFLD during routine health assessments.

Highlights

Factors associated with liver stiffness (LS) are unknown and normal reference values for LS have not been established
Liver stiffness significantly correlated with body mass index (BMI) in all participants (Table 2)
Mean LS based on BMI (ANOVA p < 0.0001; Figure 2) and the proportion of those with LS beyond the normal upper limit (x2 = 14.31, p = 0.0008) significantly differed among the three groups

Summary

Introduction

Factors associated with liver stiffness (LS) are unknown and normal reference values for LS have not been established. Individuals at high risk for alcoholic (ALD) and non-alcoholic fatty (NAFLD) liver disease need to be non-invasively discriminated during routine health checks. Liver biopsy is the gold standard for diagnosing chronic liver disease and for determining the extent of liver fibrosis, adverse effects and sampling errors are associated with the procedure [2,3,4,5,6,7], because a standard liver biopsy samples only about 1/50,000 of the liver [8]. The role of the liver biopsy in nonalcoholic fatty liver disease (NAFLD) is controversial. Arguments against routine liver biopsy include the generally benign course of NAFLD, the absence of established effective therapies even when findings indicate a need for treatment, and the risks associated with liver biopsy [9]. Efforts have been made to diagnose NASH using various imaging studies and blood tests, but the outcome has remained inadequate [10]

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Conclusion