Evaluation Of Fatty Liver Research Articles

Discordance diagnosis between B-mode ultrasonography and MRI proton density fat fraction for fatty liver

We aimed to evaluate the frequency and causes of discordant results in fatty liver (FL) diagnosis between B-mode ultrasonography (B-USG) and magnetic resonance imaging proton density fat fraction (MRI-PDFF). We analyzed patients who underwent both B-USG and MRI-PDFF within a 6-month interval. We made a confusion matrix for FL diagnosis between B-USG and MRI-PDFF and identified four discordant groups as follows: (1) the “UFL-MnFL-wo” group [B-USG FL–MRI-PDFF no FL without chronic liver disease (CLD) or liver cirrhosis (LC)]; (2) the “UFL-MnFL-w” group (B-USG FL–MRI-PDFF no FL with CLD or LC); (3) the “UnFL-MFL-wo” group (B-USG no FL–MRI-PDFF FL without CLD or LC); and (4) the “UnFL-MFL-w” group (B-USG no FL–MRI-PDFF FL with CLD or LC). We compared the “UFL-MnFL-wo” group with the control group in terms of various parameters. We found 201 patients (201/1514, 13.3%) with discordant results for FL diagnosis between B-USG and MRI-PDFF. The “UFL-MnFL-wo” group accounted for the largest portion at 6.8% (103/1514), followed by the “UFL-MnFL-w” group (79/1514, 5.2%) and the “UnFL-MFL-w” group (16/1514, 1.1%). The mean and right PDFF values, body mass index, and abdominal wall thickness were significantly higher in the “UFL-MnFL-wo” group than in the control group (p ≤ 0.001). The frequency of discordant results in the diagnosis of FL between B-USG and MRI-PDFF could be identified. The causes of discordant results were that B-USG was fairly accurate in diagnosing FL disease and that accompanying CLD or LC hindered the evaluation of FL.

Evaluation of fatty liver with grey scale 2D ultrasonography and ultrasound elastography and co-relation with lipid profile in adult patient in the state of Chhattisgarh attending Dr. Bhim Rao Ambedkar memorial hospital tertiary care centre Raipur

Background: Several noninvasive imaging techniques have been introduced for the assessment of liver fibrosis. Among these techniques real-time Point shear wave elastography has become a promising imaging modality for the measurement of liver stiffness. The advantage of this technique is that the elasticity displayed using a B-mode image, also a quantitative estimation of liver stiffness is performed. The present study evaluates the fatty liver in patients above 18 years age with grey scale 2D ultrasonography and ultrasound elastography and also study the correlation with lipid profile in patients attending Dr B.R.A.M hospital tertiary care center Raipur, Chhattisgarh. Methods: This was a hospital based observational study conducted in Department of Radio-diagnosis, Dr BRAM Hospital and Pt JNM Medical College, Raipur (C.G). A sample of 198 patient above 18-year age with fatty liver were taken. Grading and quantification of fatty liver was also done by Shear wave elastography. A p-value <0.05 was considered statistically significant. Results: Mean age of study subjects was 48.47±15.21 years and 52.02% were female. 2D ultrasound technique diagnosed 75.25% grade-1 and 24.24% were in grade-II. Elastography technique diagnosed 57.58% with dysfunction (F1) liver stiffness, 28.28% fibrosis present (F2 or F3) and 13.64% normal. Increasing liver stiffness stages was significantly associated with increasing levels of serum VLDL (p=0.04). Conclusions: Ultrasound used in conjunction with elastography has shown utility in diagnosing and follow up of fatty liver patients. Liver stiffness was significantly associated with increasing levels of serum VLDL.

1456-P: Identifying Diabetic and Prediabetic Patients Who Require Pharmacotherapy for Nonalcoholic Steatohepatitis Using the FAST Score

New pharmacologic agents to treat fatty liver in diabetics are expected to be approved in 2020 and will target those with nonalcoholic steatohepatitis (NASH) and significant fibrosis (NASH-F). The FAST (Fibroscan + AST) score was recently developed to predict the presence of (NASH-F) based on measuring controlled attenuation parameter (CAP) for steatosis, liver stiffness measurement (LSM) for fibrosis, and AST for inflammation. The aim of this study was to assess the utility of FAST score in patients with T2DM and prediabetes to identify those that require NASH pharmacotherapy. Methods: Consecutive patients with T2DM or A1c ≥5.7% who presented for evaluation of fatty liver were included. All had Fibroscan to measure CAP and LSM + AST within 6 months. Based on published data, FAST ≥0.75 was used to rule in the presence of NASH-F and therefore as an indication for pharmacotherapy. FAST < 0.40 was used to rule out NASH-F. Nominal and continuous variables were analyzed with chi-squared and 2-sided T-tests, respectively. Results: 90 patients were identified; average age 56 (13.55) years, BMI was 35.06 (6.29) kg/m2, and 58 (64.4%) were female. A total of 11 (12.3%) patients had a FAST ≥0.75 indicating that they qualify for pharmacotherapy once available. Patients with FAST ≥0.75 were older (57.3 years vs. 47; p=0.01), had higher ALT (139.63 u/L vs. 57.06; p <0.01), and triglycerides (234.87 mg/dL vs. 162.44; p =0.02). Patients with FAST ≥0.75 were not more likely to have higher A1c, hypertension, or metabolic syndrome. 34 patients (37.7%) had FAST <0.4 indicating the absence of significant disease and 45 patients (50%) had FAST between 0.4 and 0.75. Conclusion: Using a high cutoff value of 0.75, the FAST score identified 12% of patients with T2DM/prediabetes that will qualify for NASH pharmacotherapy. While 38% of patients can be stratified as low risk by using a cutoff value of 0.40, 50% of patients had intermediate FAST score values indicating the need for further workup. Disclosure P. Aggarwal: None. N. Alkhouri: Research Support; Self; Allergan plc.

Evaluation of Fatty Liver by Ultrasonography, Investigation of Associations with Metabolic Factors

Evaluation of Fatty Liver by Ultrasonography, Investigation of Associations with Metabolic Factors

Docosahexaenoic acid enrichment in NAFLD is associated with improvements in hepatic metabolism and hepatic insulin sensitivity: a pilot study

Background/Objective:Treatment of subjects with non-alcoholic fatty liver disease (NAFLD) with omega-3 polyunsaturated fatty acids (FAs) suggests high levels of docosahexaenoic acid (DHA) tissue enrichment decrease liver fat content. We assessed whether changes in erythrocyte DHA enrichment (as a surrogate marker of changes in tissue enrichment) were associated with alterations in hepatic de novo lipogenesis (DNL), postprandial FA partitioning and hepatic and peripheral insulin sensitivity in a sub-study of the WELCOME trial (Wessex Evaluation of fatty Liver and Cardiovascular markers in NAFLD (non-alcoholic fatty liver disease) with OMacor thErapy).Subjects/Methods:Sixteen participants were randomised to 4 g/day EPA+DHA (n=8) or placebo (n=8) for 15–18 months and underwent pre- and post-intervention measurements. Fasting and postprandial hepatic FA metabolism was assessed using metabolic substrates labelled with stable-isotope tracers (2H2O and [U13C]palmitate). Insulin sensitivity was measured by a stepped hyperinsulinaemic-euglycaemic clamp using deuterated glucose. Participants were stratified according to change in DHA erythrocyte enrichment (< or ⩾2% post intervention).Results:Nine participants were stratified to DHA⩾2% (eight randomised to EPA+DHA and one to placebo) and seven to the DHA<2% group (all placebo). Compared with individuals with erythrocyte <2% change in DHA abundance, those with ⩾2% enrichment had significant improvements in hepatic insulin sensitivity, reduced fasting and postprandial plasma triglyceride concentrations, decreased fasting hepatic DNL, as well as greater appearance of 13C from dietary fat into plasma 3-hydroxybutyrate (all P<0.05).Conclusions:The findings from our pilot study indicate that individuals who achieved a change in erythrocyte DHA enrichment ⩾2% show favourable changes in hepatic FA metabolism and insulin sensitivity, which may contribute to decreasing hepatic fat content.

Is fatty liver indicative of a risk of metabolic syndrome among non-obese subjects?

Metabolic syndrome (MetS), a complex of interrelated risk factors for cardiovascular disease (CVD), includes elevated fasting plasma glucose (FPG) levels, elevated blood pressure (BP), elevated triglyceride (TG) levels, reduced highdensity lipoprotein cholesterol (HDL-C) levels, and obesity [1]. Obesity seems to be a central metabolic risk factor (MetRF) because insulin resistance, which is generally related to obesity, is a potential pathophysiologic link among MetRF. In this context, obesity, as measured by abdominal adiposity and increased waist circumference, is included as an essential factor for diagnosis of MetS by the International Diabetes Federation (IDF) and the Japanese Examination Committee for Criteria of Metabolic Syndrome [2, 3]. However MetRF were frequently clustered, even among non-obese subjects. Subjects with clustering of MetRF are often insulin-resistant compared with subjects without clustering of MetRF, even though they were not obese. Thus, non-obese subjects with a clustering of MetRF are at increased risk of CVD, as are obese subjects with a clustering of MetRF, or subjects with MetS. Thus, evaluation of MetRF seems to be important for finding such individuals. Recently, Hiraoka et al. reported an association of fatty liver with MetRF and such insulin-resistance indices as HOMA-R among non-obese subjects with normal waist circumference none of whom met the MetS criteria [4]. Blood pressure, serum triglyceride, and HOMA-R levels were significantly elevated among non-obese subjects with normal waist circumference and fatty liver compared to those without (males: 122/78 vs. 120/76 mmHg, 161.5 vs. 105.5 mg/dl, 1.9 vs. 1.3, respectively; females: 120/73 vs. 116/71 mmHg, 115.2 vs. 82.0 mg/dl, 1.7 vs. 1.3, respectively). This result indicated that those with fatty liver were at risk of clustering of MetRF and, thus, of developing MetS, even though they were not obese or did not meet the MetS criteria. Therefore, evaluation of fatty liver, which can be detected easily by ultrasonography in ordinary clinical settings, seems to be important for non-obese and obese individuals. Furthermore, because the authors excluded those who regularly drank 20 g or more alcohol per day from their study population, the fatty liver described in the report seems to be non-alcoholic fatty liver disease (NAFLD) [4]. Studies of MetS have revealed a J-shaped relationship between alcohol intake and the risk of MetS [5–7]. Indeed, light alcohol consumption was actually associated with a lower risk of MetS [6–8] whereas very heavy alcohol consumption was associated with a substantial increase in the risk of MetS [9]. However, the different relationships between alcohol intake and the risk of clustering of MetRF might be related to the different obesity of the subjects, i.e. non-obese versus obese. We recently reported that alcohol intake by non-obese males with a clustering of MetRF was significantly higher than by those without, but such differnce was not observed in obese males [10]. Furthermore, analysis of non-obese males stratified into the four groups on the basis of alcohol consumption (none, light (1–139 g/ week), heavy (140–279 g/week), and very heavy (]280 g/ week)) revealed a positive linear association between amount of alcohol intake and clustering of MetRF [10], i.e., increasing alcohol intake seemed to increase the risk of clustering of MetRF among non-obese Japanese males whereas non-obese individuals with no or light alcohol & Makoto Daimon mdaimon@hirosaki-u.ac.jp

Metabolic Syndrome, Insulin Resistance and Fatty Liver in Obese Iranian Children

Background:Obesity is a global epidemic and its morbidities such as metabolic syndrome, insulin resistance, and fatty liver leads to a spectrum of psycho-social and medical consequences.Objectives:The objective of this study was to investigate the prevalence of fatty liver in obese Iranian children and its' association with metabolic syndrome and insulin resistance.Patients and Methods:102 obese Iranian children, referred to pediatric clinics from March 2011 to March 2012, were enrolled in this cross-sectional study. All the patients were visited by a pediatric endocrinologist, a pediatric gastroenterologist and an expert radiologist in the evaluation of fatty liver grading.Results:The grade of fatty liver was higher in older children (P = 0.001). It was also more in taller and heavier children (P = 0.000). The more the BMI was, the more the fatty liver grade was (P = 0.002). Severity of fatty liver according to liver sonography in patient had a positive relationship with waist circumference, hip circumference, serum TG, serum FBS, serum fasting insulin, serum ALT, systolic blood pressure and HOMA index and had a negative correlation with the level of alkaline phosphatase. Severity of fatty liver also had a close relationship with the presence of acanthosis nigricans and HOMA index.Conclusions:Prevalence of fatty liver is high in our obese children. It was associated with criteria of metabolic syndrome and insulin resistance, so visceral fat may participate in the pathogenesis of the metabolic syndrome or merely serve as a marker of increased risk for the metabolic complications of obesity.

Evaluation of fatty liver by using in-phase and opposed-phase MR images and in-vivo proton MR spectroscopy

The purpose of this study was to evaluate the necessity of in-phase and opposed-phase MR images and their correlations with weight, the aspartate aminotransferase/alanine aminotransferase (AST/ALT) value, and age. Magnetic resonance spectroscopy (MRS) was used as a reference in this study. We selected 68 people as subjects, among which 14 were volunteers with normal AST/ALT values (<40/35 U/L) on a liver function study and 54 were non-alcoholic fatty liver patients for whom ultrasonic images had been obtained within 3 months of the study. In this study, the liver was more enhanced than the spleen or kidney. When the Eq. (3) formula was applied to normal volunteers, the difference between the in-phase and the opposed-phase images was −3.54 ± 12.56. The MRS study result showed a high sensitivity of 96.6% and a specificity of 100% (p = 0.000) when the cutoff value was 20%. Furthermore, this result showed a high sensitivity of 94% and a specificity of 80% with a similar cutoff when the Eq. (2) formula was applied to non-alcoholic fatty liver patients (p = 0.000). The MRS study revealed a strong correlation between normal volunteers and non-alcoholic fatty liver patients (r = 0.59, p = 0.04). The correlations between AST/ALT and Eq. (3) (r = 0.45, p = 0.004), age and Eq. (3) (r = 0.73, p = 0.03), and weight and Eq. (3) (r = 0.77, p = 0.000) values were all statistically significant. In the case of non-alcoholic liver disease, MRS was found to be significantly correlated with Eq. (1) (r = 0.39, p = 0.002), Eq. (2) (r = 0.68, p = 0.04), Eq. (3) (r = 0.67, p = 0.04), and AST/ALT (r = 0.77, p = 0.000). In conclusion, in-phase and opposed-phase images can help to distinguish a normal liver from a fatty liver in order to identify non-alcoholic fatty liver patients. The intensity difference between the in-phase and opposed-phase MR signals showed valuable correlations with respect to weight, AST/ALT value, and age, with all values being above the mild lipid value (r = 0.3).

第25回日本総合健診医学会学術大会講演抄録集 超音波法による脂肪肝の評価

第25回日本総合健診医学会学術大会講演抄録集 超音波法による脂肪肝の評価

Evaluation of Fatty Liver by Computed Tomography in Human

Evaluation of Fatty Liver by Computed Tomography in Human