Clinical relevance of lipid panel and transaminases according liver steatosis and fibrosis measured by transient elastography (Fibroscan®)
Abstract
Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most frequent causes of chronic liver disease and it is related with co-morbilities as the metabolic syndrome. Transient elastography (Fibroscan®) is a non-invasive method to detect NAFLD using the controlled attenuation parameter (CAP). Methods. Patients with NAFLD were included. Hepatic steatosis was quantified by CAP (dB/m) and liver stiffness by Kilopascals (kPa), and were correlated with lipid profile and aspartate transaminase (AST) and alanine transaminase (ALT) transamase. In the statistical analysis, correlation and multiple regression were used. Mann-Whitney U test was used as non-parametric analysis for comparison of medians Results: One hundred five patients were included. In the multiple regression analysis, we observed an association between hepatic steatosis and total cholesterol (B = 0.021, p = 0.038, Exp (B) = 1.021, I.C = 1.001–1.041) and triglycerides (B = 0.017, p = 0.006, Exp (B) = 1.018 and I.C = 1.005–1.030). In the same way, an association between significant hepatic fibrosis and concentrations of total cholesterol (B = -0.019, p = 0.005, Exp (B) = 0.982 I.C = 0.969–0.995) and AST (B = 0.042, p = 3.25 x 10-4, Exp (B) = 1.043 I.C = 1.019–1.068) independently of age, gender, BMI. Conclusions: Our results suggest that total cholesterol and triglycerides concentrations are associated with liver steatosis and significant hepatic fibrosis are associated with lower total cholesterol and higher AST concentrations in patients with NAFLD according Fibroscan®.
References
Younossi Z, Anstee QM, Marietti M, Hardy T, Henry L, Eslam M, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nature reviews Gastroenterology & hepatology. 2018;15(1):11-20.
Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM, et al. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. The New England journal of medicine. 2010;362(18):1675-85.
Angulo P. Nonalcoholic fatty liver disease. The New England journal of medicine. 2002;346(16):1221-31.
Fabbrini E, Magkos F, Mohammed BS, Pietka T, Abumrad NA, Patterson BW, et al. Intrahepatic fat, not visceral fat, is linked with metabolic complications of obesity. Proceedings of the National Academy of Sciences of the United States of America. 2009;106(36):15430-5.
Nassir F, Rector RS, Hammoud GM, Ibdah JA. Pathogenesis and Prevention of Hepatic Steatosis. Gastroenterology & hepatology. 2015;11(3):167-75.
Mikolasevic I, Orlic L, Franjic N, Hauser G, Stimac D, Milic S. Transient elastography (FibroScan((R))) with controlled attenuation parameter in the assessment of liver steatosis and fibrosis in patients with nonalcoholic fatty liver disease - Where do we stand? World journal of gastroenterology. 2016;22(32):7236-51.
Chon YE, Jung KS, Kim SU, Park JY, Park YN, Kim DY, et al. Controlled attenuation parameter (CAP) for detection of hepatic steatosis in patients with chronic liver diseases: a prospective study of a native Korean population. Liver international : official journal of the International Association for the Study of the Liver. 2014;34(1):102-9.
Sasso M, Miette V, Sandrin L, Beaugrand M. The controlled attenuation parameter (CAP): a novel tool for the non-invasive evaluation of steatosis using Fibroscan. Clinics and research in hepatology and gastroenterology. 2012;36(1):13-20.
Wong VW, Vergniol J, Wong GL, Foucher J, Chan HL, Le Bail B, et al. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology. 2010;51(2):454-62.
Friedrich-Rust M, Hadji-Hosseini H, Kriener S, Herrmann E, Sircar I, Kau A, et al. Transient elastography with a new probe for obese patients for non-invasive staging of non-alcoholic steatohepatitis. European radiology. 2010;20(10):2390-6.
Kim SU, Ahn SH, Park JY, Kang W, Kim DY, Park YN, et al. Liver stiffness measurement in combination with noninvasive markers for the improved diagnosis of B-viral liver cirrhosis. Journal of clinical gastroenterology. 2009;43(3):267-71.
Castera L, Forns X, Alberti A. Non-invasive evaluation of liver fibrosis using transient elastography. Journal of hepatology. 2008;48(5):835-47.
Yoneda M, Yoneda M, Fujita K, Inamori M, Tamano M, Hiriishi H, et al. Transient elastography in patients with non-alcoholic fatty liver disease (NAFLD). Gut. 2007;56(9):1330-1.
Kim JK, Fillmore JJ, Chen Y, Yu C, Moore IK, Pypaert M, et al. Tissue-specific overexpression of lipoprotein lipase causes tissue-specific insulin resistance. Proceedings of the National Academy of Sciences of the United States of America. 2001;98(13):7522-7.
Gaggini M, Morelli M, Buzzigoli E, DeFronzo RA, Bugianesi E, Gastaldelli A. Non-alcoholic fatty liver disease (NAFLD) and its connection with insulin resistance, dyslipidemia, atherosclerosis and coronary heart disease. Nutrients. 2013;5(5):1544-60.
Donnelly KL, Smith CI, Schwarzenberg SJ, Jessurun J, Boldt MD, Parks EJ. Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease. J Clin Invest. 2005;115(5):1343-51.
Marra F, Svegliati-Baroni G. Lipotoxicity and the gut-liver axis in NASH pathogenesis. Journal of hepatology. 2018;68(2):280-95.
DeFilippis AP, Blaha MJ, Martin SS, Reed RM, Jones SR, Nasir K, et al. Nonalcoholic fatty liver disease and serum lipoproteins: the Multi-Ethnic Study of Atherosclerosis. Atherosclerosis. 2013;227(2):429-36.
Loria P, Marchesini G, Nascimbeni F, Ballestri S, Maurantonio M, Carubbi F, et al. Cardiovascular risk, lipidemic phenotype and steatosis. A comparative analysis of cirrhotic and non-cirrhotic liver disease due to varying etiology. Atherosclerosis. 2014;232(1):99-109.
Yamaguchi K, Yang L, McCall S, Huang J, Yu XX, Pandey SK, et al. Inhibiting triglyceride synthesis improves hepatic steatosis but exacerbates liver damage and fibrosis in obese mice with nonalcoholic steatohepatitis. Hepatology. 2007;45(6):1366-74.
Musso G, Gambino R, De Michieli F, Cassader M, Rizzetto M, Durazzo M, et al. Dietary habits and their relations to insulin resistance and postprandial lipemia in nonalcoholic steatohepatitis. Hepatology. 2003;37(4):909-16.
Yasutake K, Kohjima M, Kotoh K, Nakashima M, Nakamuta M, Enjoji M. Dietary habits and behaviors associated with nonalcoholic fatty liver disease. World journal of gastroenterology. 2014;20(7):1756-67.
Yasutake K, Nakamuta M, Shima Y, Ohyama A, Masuda K, Haruta N, et al. Nutritional investigation of non-obese patients with non-alcoholic fatty liver disease: the significance of dietary cholesterol. Scandinavian journal of gastroenterology. 2009;44(4):471-7.
Choi SH, Ginsberg HN. Increased very low density lipoprotein (VLDL) secretion, hepatic steatosis, and insulin resistance. Trends in endocrinology and metabolism: TEM. 2011;22(9):353-63.
Privitera G, Spadaro L, Marchisello S, Fede G, Purrello F. Abnormalities of Lipoprotein Levels in Liver Cirrhosis: Clinical Relevance. Digestive diseases and sciences. 2018;63(1):16-26.
Tietge UJ, Boker KH, Bahr MJ, Weinberg S, Pichlmayr R, Schmidt HH, et al. Lipid parameters predicting liver function in patients with cirrhosis and after liver transplantation. Hepato-gastroenterology. 1998;45(24):2255-60.
Patton HM, Lavine JE, Van Natta ML, Schwimmer JB, Kleiner D, Molleston J, et al. Clinical correlates of histopathology in pediatric nonalcoholic steatohepatitis. Gastroenterology. 2008;135(6):1961-71 e2.
Shimada M, Hashimoto E, Kaneda H, Noguchi S, Hayashi N. Nonalcoholic steatohepatitis: risk factors for liver fibrosis. Hepatology research : the official journal of the Japan Society of Hepatology. 2002;24(4):429-38.
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