OR24-05 High Waist Circumference Is Strongly Predictive Of Hepatic Steatosis And Significant Fibrosis

Abstract

Abstract Disclosure: N. Janakiram: None. S. Puri: None. A. Thirumalai: None. Vibration-controlled transient elastography (TE) can measure controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) in non-alcoholic fatty liver disease (NAFLD) patients. A high skin-to-capsule distance can challenge the accuracy of this imaging technique. Therefore, high waist circumference (WC), a known risk factor for NAFLD, can hamper assessment in high-risk patients. Studies investigating the relationship between WC and TE measurements have yielded conflicting results. We used the 2017-2018 National Health and Nutrition Examination Survey (NHANES) data to explore this relationship in a large cohort of the general population. We hypothesized that high WC would be associated with (1) higher failure rate for completion of TE, (2) worse CAP and LSM measurements and (3) be predictive of presence of steatosis and significant fibrosis. We summarized the primary reason for incomplete TE in normal and high WC participants of male (M; WC ≥ 102 cm = high) and female (F; WC ≥ 88 cm = high) gender. We compared mean CAP and LSM between normal and high WC participants using unpaired t-tests. We calculated area under receiver operator curve (AUROC) for WC predicting presence of steatosis (CAP ≥248 dB/m) and significant fibrosis (LSM ≥8 kPa) and compared this with fibrosis-4 (FIB-4) and NAFLD fibrosis scores (NFS). We analyzed the 5757 patients (2880 F, 2877 M) with complete or partial TE status, based on WC. Proportion of patients with partial TE status was higher in those with high WC (8.9% F, 9% M) than normal WC patients (6.5% F, 6.4% M). We analyzed the 446 patients with partial TE status (231 F, 215 M) by cause. The proportion of patients who were unable to complete TE, either due to an IQR/medium > 30% or not having 10 valid measurements among the high WC population (66%) was significantly higher than those with normal WC (23%), in both women (X2 (1, n=231) = 29.63; p<.001) and men (X2 (1, n=215) = 49.43; p<.001).Among those with complete TE (n=2313; 1090 M, 1223 F), mean CAP was significantly higher (p<0.001) in high WC patients (308 dB/m M, 278 dB/m F) compared to normal WC patients (250 dB/m M, 225 dB/m F). Mean LSM was significantly higher (p<0.001) in high WC patients (6.8 kPa M, 5.7 kPa F) compared to normal WC patients (5.7 kPa M, 4.5 kPa F). The AUROC for WC predicting presence of steatosis was 0.77 in F and 0.80 in M (p<0.001 for both). The AUROC for WC predicting the presence of significant fibrosis (≥8 kPa) was 0.73 in F and 0.71 in M (p<0.001 for both). In AUROC analyses, WC performed better than FIB-4 and NFS in predicting presence of significant fibrosis and steatosis. Therefore, we conclude that high WC is more likely to result in an incomplete TE, but among those with a valid exam, it is highly predictive of presence of steatosis and significant fibrosis. Presentation: Saturday, June 17, 2023