Can FIB4 and NAFLD fibrosis scores help endocrinologists refer patients with non-alcoholic fat liver disease to a hepatologist?

Nones, Rodrigo Bremer; Ivantes, Cláudia Pontes; Pedroso, Fiona L.

doi:10.1590/2359-3997000000233

Cited by 26 publications

(22 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In recent years, a need for non‐invasive diagnostic methods to assess liver damage has been noted, i.e. methods to identify symptoms of liver fibrosis that indicate possible development of advanced liver fibrosis or cirrhosis without the need for a liver biopsy . The FIB‐4 scoring system is a non‐invasive laboratory test to diagnose liver fibrosis in patients with NAFLD and is calculated using AST values, ALT values, platelet levels and age.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of canagliflozin against nonalcoholic fatty liver disease: a prospective cohort study

Itani¹,

Ishihara²

2018

Obesity Science & Practice

View full text Add to dashboard Cite

SummaryBackgroundNonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease worldwide and is characterized by insulin resistance, hepatic steatosis and often prediabetes or diabetes. Canagliflozin, a selective sodium glucose cotransporter 2 inhibitor, is a new oral anti‐diabetic drug that reduces hyperglycaemia by promoting urinary glucose excretion. Glycosuria produced by canagliflozin is associated with weight loss, mainly due to reduced fat volume and improve insulin resistance. Reduced body weight and improvement of insulin resistance by canagliflozin may be an effective treatment for NAFLD.MethodsThirty‐five patients with NAFLD (17 men and 18 women) were enrolled and administered canagliflozin (100 mg). Body weight and serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma‐glutamyl transferase (γ‐GTP), low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol, triglycerides (TG), blood sugar (BS), glycated haemoglobin (HbA1C), uric acid (UA) and ferritin, and fibrosis‐4 (FIB‐4) index values were measured at baseline and at 3‐month and 6‐month follow‐up visits.ResultsBody weight and serum levels of AST, ALT, γ‐GTP, TG, UA, HbA1C, BS and ferritin decreased significantly after 3 and 6 months of canagliflozin treatment. Serum BS levels and FIB‐4 index values decreased slightly following 3 months of treatment; these results reached significance after 6 months. Reduced serum ALT levels at 6 months were significantly correlated with baseline HbA1C and ferritin levels. Moreover, a significant correlation between reduced body weight and serum ALT levels was observed at 6 months. Decreased serum ALT levels were significantly correlated with decreased serum ferritin at 6 months.ConclusionsCanagliflozin significantly reduced the serum levels of BS, HbA1C, TG, UA and ferritin, as well as FIB‐4 index values and body weight, with improved liver function. Sodium glucose cotransporter 2 inhibitors may be an important therapeutic modality for improving liver injury in NAFLD patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Efficacy of canagliflozin against nonalcoholic fatty liver disease: a prospective cohort study

Itani¹,

Ishihara²

2018

Obesity Science & Practice

View full text Add to dashboard Cite

show abstract

“…NAFLD fibrosis score (NFS), which estimates the severity of liver fibrosis, were calculated based on Angulo’s formula using 7 variables = -1.675 + 0.037 x age (years) + 0.094 x BMI (kg/m 2 ) + 1.13 x IFG (Impaired fasting glucose)/diabetes (yes = 1, no = 0) + 0.99 x AST/ALT ratio—0.013 x platelet (x 10 9 /l) -0.66 x albumin (g/dl) [ 22 ]. FIB-4 was calculated using the formula: age x AST / [platelet count (10 9 /L) x (ALT) 1/2 ] as the index for liver fibrosis of different stages associated to cirrhosis [ 6 ].…”

Section: Methodsmentioning

confidence: 99%

“…The gold standard definition of NAFLD is fat acumination >5% in liver by histology without a history of significant alcohol consumption [ 4 , 5 ]. Since current evidence does not support routine use of a liver biopsy in patients with suspected NAFLD or NASH [ 4 ], non-invasive tests such as liver enzyme levels, medical images, Fatty Liver Index, NAFLD fibrosis score (NFS), fibrosis-4 (FIB-4), and ultrasound methods are widely used as surrogate indicators [ 4 , 6 ]. Abdominal ultrasound is a safe and convenient method for the diagnosis of NAFLD [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

One-year weight management lowers lipopolysaccharide-binding protein and its implication in metainflammation and liver fibrosis

et al. 2018

View full text Add to dashboard Cite

BackgroundStudies showed that the endotoxemia-related biomarker, lipopolysaccharide-binding protein (LBP), is associated with obesity and fatty liver. The level of LBP is reduced after surgical weight loss. This study aimed to verify the change of serum LBP levels after one-year medical weight management in subjects with obesity.Methods and findingsA total of 62 subjects with obesity, 39 subjects with overweight, and 21 subjects with normal body mass index were enrolled for a one-year weight management program. Basic information, body composition analysis, clinical data, serum LBP level, and abdominal ultrasonography findings were collected. At baseline, the serum LBP levels of the obese and overweight subjects were significantly higher than that of the normal group (30.9±7.4 and 29.6±6.3 versus 23.1±5.6 μg/mL, respectively, p<0.001). Serum LBP in subjects with obesity was significantly reduced to 26.5±7.1 μg/mL (p-value < 0.001) after one year. In the multivariate analyses, LBP was associated with high sensitive C-reactive protein (hs-CRP) and non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) before weight management in the obese group. Moreover, the change of LBP in response to weight management was significantly related to the changes of hs-CRP, leukocyte count and NFS by multivariate linear regression analysis also in the obese group.ConclusionThe serum level of the endotoxemia-related biomarker, LBP, decreases after one-year weight management in the obese subjects. In addition to serving as a metainflammatroy biomarker like hs-CRP, LBP may also be a potential biomarker as a non-invasive biomarker for the evaluation of liver fibrosis in NAFLD.

show abstract

“…Patients who underwent liver biopsy and noninvasive scores for assessing steatohepatitis and liver fibrosis in previously study were included (9) . Patients underwent clinical, laboratory, and elastography examination, defining the current level of hepatic fibrosis, about 10 years after the first evaluation.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Progression of Hepatic Fibrosis in a Group of Patients With Non-Alcoholic Fatty Liver Disease Accompanied for 10 Years

Castro

Alberton

Pedroso

et al. 2019

Arq. Gastroenterol.

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Non-alcoholic fatty liver disease has been progressively diagnosed in the general population as a consequence of the increased prevalence of obesity and type 2 diabetes mellitus, its main risk factors. It is characterized by accumulation of fat in the hepatocytes associated with lobular inflammation and balonization, which can lead to cirrhosis and hepatocarcinoma. Thus, a characterization and follow-up of a progression of the fibrosis level of these patients becomes important, being that the transient hepatic elastography is a reliable method for this evaluation with a measure of the kapa index. OBJECTIVE: To evaluate the progression of hepatic fibrosis through elastography in patients with non-alcoholic fatty liver disease. METHODS: Patients who had previously performed hepatic biopsy and noninvasive scores for non-alcoholic steatohepatitis (NASH) and fibrosis were included in the study. These same subjects were then submitted to current clinical evaluation, laboratory and liver elastography tests, defining the level of liver fibrosis, about 10 years after the first evaluation. RESULTS: Data were analyzed for 66 patients previously submitted to liver biopsy. Of these, 16 were not found, four could not participate because they were debilitated due to hepatic cirrhosis, two had died from an automobile accident and five from complications of cirrhosis of the liver. Therefore, of the 50 patients with a known history, 9 (18%) had died of cirrhosis or were unable to attend the examination because of their liver disease. The remaining population was predominantly female (61.5%), mean age of 63 years, being overweight, dyslipidemia (76.9%), disorders of the glycemic profile (76.9%), and metabolic syndrome (82.1%). Of the 39 cases evaluated, 35% had the same degree of fibrosis at the initial evaluation (biopsy) and at the current evaluation (elastography), 33% had an increase in the degree of fibrosis and another 30% had a decrease in the degree of fibrosis. Twenty-eight patients had NASH at baseline. Regarding these patients, it was observed in the current evaluation, that 25% remained stable in the degree of fibrosis, 39% progressed, and 35% regressed. CONCLUSION: Despite some limitations of our study, such as the small number of patients, and the use of two different methods of evaluation (biopsy and elastography), the data obtained allow us to conclude that of the 39 evaluated cases, 33% (13) presented progression of fibrosis and the total group of 50 patients, 42% had cirrhosis or died due to liver disease. The presence of NASH on hepatic biopsy did not prove to be, in our study, a predictive of the evolution of hepatic fibrosis in the patients.

show abstract

Can FIB4 and NAFLD fibrosis scores help endocrinologists refer patients with non-alcoholic fat liver disease to a hepatologist?

Cited by 26 publications

References 45 publications

Efficacy of canagliflozin against nonalcoholic fatty liver disease: a prospective cohort study

Efficacy of canagliflozin against nonalcoholic fatty liver disease: a prospective cohort study

One-year weight management lowers lipopolysaccharide-binding protein and its implication in metainflammation and liver fibrosis

Evaluation of Progression of Hepatic Fibrosis in a Group of Patients With Non-Alcoholic Fatty Liver Disease Accompanied for 10 Years

Contact Info

Product

Resources

About