Abstract
Background/ObjectivesRenaming non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated fatty liver disease (MAFLD) suggests a shift of emphasis to the accompanying metabolic disturbance. Controlled attenuation parameter (CAP) measured by FibroScan has been shown to be correlated with hepatic steatosis. We aim to validate its usefulness as a novel surrogate marker for evaluating metabolic derangement.Subjects/MethodsVolunteers were recruited from medical staff at our hospital to undergo CAP measurements. Anthropometrics, CAP, and laboratory assessments for metabolic profiles and insulin resistance were collected. CAP < 238 dB/m denoted no hepatic steatosis, 238 ≤ CAP ≤ 259 dB/m denoted mild, 260 ≤ CAP ≤ 291 dB/m denoted moderate, and CAP > 291 dB/m denoted severe hepatic steatosis according to previous reports.ResultsData of 824 participants were included for analysis. The age was 53.2 ± 15.4 years, body mass index (BMI) was 23.6 ± 3.1 kg/m2, 24.4% were male subjects, and 22.0% met the criteria for metabolic syndrome (MetS). Taking the group with CAP < 238 dB/m as control, subjects with mild, moderate, and severe hepatic steatosis had increased odds of MetS by 3.51-, 3.32-, and 5.12-fold, respectively, after adjusting for multiple confounders (p = 0.020). Metabolic profiles, insulin resistance, and presence of MetS were similar between normal-weight subjects with CAP ≥ 238 dB/m and overweight subjects with CAP < 238 dB/m. Even in subjects with no MetS components, those with CAP ≥ 238 dB/m had higher BMI, waist circumferences, uric acid, triglyceride, white blood cell count, and insulin resistance, whereas lower adiponectin and estimated glomerular filtration rate. Waist circumference [OR 1.11 (1.04, 1.18), p = 0.001] and homeostatic model assessment of insulin resistance (HOMA-IR) [OR 2.39 (1.18, 4.83), p = 0.016] were predictive of hepatic steatosis according to CAP ≥ 238 dB/m.ConclusionsCAP is a convenient, sensitive, and non-invasive indicator for metabolic derangement. Prospective studies are needed to further validate its usefulness as a surrogate marker for the transition of metabolic status over time.
Highlights
Non-alcoholic fatty liver disease (NAFLD) affects nearly one billion people worldwide and is expected to be the leading cause of end-stage liver disease in the coming decades (1)
We showed that CAP is a convenient and sensitive non-invasive surrogate marker for early detection of metabolic derangement in a population with lower risk
The major benefit of detecting hepatic steatosis in apparently healthy individuals is to identify the underlying metabolic derangement, allowing the initiation of early intervention through lifestyle modification. This is of particular importance for the Asian population with a substantial proportion of lean NAFLD
Summary
Non-alcoholic fatty liver disease (NAFLD) affects nearly one billion people worldwide and is expected to be the leading cause of end-stage liver disease in the coming decades (1). Metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed to replace NAFLD. Rather than an “exclusion criteria”, “positive criteria” have been adopted to diagnose MAFLD, which are based on evidence of hepatic steatosis by imaging techniques, blood biomarkers, or liver histology, in addition to one of the following 3 criteria: 1) overweight/obesity, 2) type 2 diabetes mellitus, or 3) two of the seven cardiometabolic risk factors, which largely represent the criteria for metabolic syndrome (MetS) (3). The prevalence of MAFLD is expected to be more prominent because a less rigorous criterion is employed, where alcohol consumption and other concomitant liver diseases are no longer exclusion conditions, and more sensitive and inexpensive imaging techniques have come into clinical practice. The goal of the revised nomenclature is to draw public attention to the prevention and intervention of treatable metabolic dysfunction. Since specific pharmacotherapy for fatty liver disease is lacking, detection of metabolic derangement at an earlier stage to justify immediate intervention through lifestyle change should be both efficient and economical
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