Abstract
BackgroundThe simultaneous assessment of visceral adiposity and muscle mass might be useful to monitor the risk of non-alcoholic fatty liver disease (NAFLD) progression in large population. We aimed to investigate the value of serum creatinine-to-cystatin C ratio (CCR) in evaluating these two parameters and predicting liver steatosis and fibrosis.Methods154 overweight/obese inpatients (49 males, 105 females) scheduled for bariatric surgery and 49 non-overweight/obese volunteers (18 males, 31 females) responded to the hospital advertisement were involved in the cross-sectional study. Liver steatosis and fibrosis were diagnosed with transient elastography (TE). The psoas muscle area (PMA) and visceral fat area (VFA) were measured using magnetic resonance imaging.ResultsThe body mass index, insulin resistance, and lipid profiles showed significant differences between the CCR tertiles. Multiple regression analyses revealed that the CCR was significantly associated with the controlled attenuation parameter (β = −0.30, P = 0.006 in males; β = −0.19, P = 0.017 in females) and liver stiffness measurements in males (β = −0.246, P = 0.044). A low CCR was associated with moderate-to-severe steatosis (P < 0.001), significant liver fibrosis (P < 0.01), and excellent predictive power for these two conditions (P < 0.01). The CCR had a negative correlation with the VFA/PMA ratio (r = −0.584, P < 0.001 in males; r = −0.569, P < 0.001 in females).ConclusionsThe CCR is a serum marker for muscle-adjusted visceral fat mass, and a low CCR is associated with an increased risk of progressive NAFLD.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide (Younossi et al, 2016)
The visceral fat area (VFA) and VFA/psoas muscle area (PMA) ratio were significantly higher in the lowest cystatin C ratio (CCR) tertile than the middle and highest tertile, while the PMA did not differ significantly among the three groups
Compared to the subjects in the lowest CCR tertile, subjects in the middle and highest CCR tertile presented with lower controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) and lower aspartate transaminase, alanine aminotransferase, and γ-glutamyl transferase levels, meaning that the most severe liver steatosis, fibrosis, and/or inflammation was present in the lowest CCR tertile (Table 1)
Summary
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide (Younossi et al, 2016). In 10–22% of patients, NAFLD progresses to non-alcoholic steatohepatitis, which is associated with high mortality from numerous liver and cardiovascular diseases (Bazick et al, 2015). It would be significant to identify high-risk NAFLD patients early and intensive monitoring of disease progression. Recent studies suggested that low muscle mass contributes to the risk of NAFLD progression and severe liver fibrosis (Koo et al, 2017; Petta et al, 2017). Simultaneous measurements of visceral fat and muscle mass might be an effective method for early screening and intensive monitoring of high-risk NAFLD populations. The simultaneous assessment of visceral adiposity and muscle mass might be useful to monitor the risk of non-alcoholic fatty liver disease (NAFLD) progression in large population. We aimed to investigate the value of serum creatinineto-cystatin C ratio (CCR) in evaluating these two parameters and predicting liver steatosis and fibrosis
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