Background of the FIB-4 Index in Japanese Non-Alcoholic Fatty Liver Disease

Abstract

Objective We investigated the distribution and characteristics of the FIB-4 index of liver fibrosis in 1,441 Japanese men (age 50.7±10.2 years) and 304 women (age 53.9±10.3 years) who underwent comprehensive general health checkups and were identified as having non-alcoholic fatty liver disease. With respect to the FIB-4 index, differences according to sex, metabolic indices, and ultrasonic findings were investigated. Methods Among 9,255 individuals who underwent comprehensive general health checkups, 2,750 (29.8%) were found to have mild fatty liver or fatty liver based on ultrasound findings. After excluding patients who consumed ! 150 g alcohol/week (818 individuals), those testing positive for hepatitis B surface antigens or hepatitis C virus antibody (184 individuals), and those for whom data were insufficient (three individuals), we investigated the FIB-4 indices in the remaining 1,745 subjects. Results There were no sex differences in the FIB-4 index. A total of 1,370 patients (78.5%) exhibited a low cut-off index (COI) (<1.30), 357 (20.5%), exhibited an indeterminate COI (1.30-2.67), and 18 (1.0%) exhibited a high COI (>2.67). There were no associations between the FIB-4 index and the constituent factors of metabolic syndrome. In contrast, there was a significant difference in the ln FIB-4 index between the patients with and without mild fatty liver or fatty liver on ultrasound among men (0.006±0.43 and -0.092±0.39, p<0.001), but not women. Conclusion The FIB-4 index was is significantly lower in men, but not women, with fatty liver. The FIB-4 index must be calculated separately during medical checkups and evaluated in conjunction with ultrasound findings.

FIB-4 First in the Diagnostic Algorithm of Metabolic-Dysfunction-Associated Fatty Liver Disease in the Era of the Global Metabodemic

“…Five factors of baseline low eGFR level (60-75 mL/min), aging, T2D, hypertension, and elevated GGT, increase the risk of the development of CKD [88]. High FIB-4 index is a significant risk factor for incident CVD, and patients with increased FIB-4 index showed larger reduction in eGFR compared with those with decreased FIB-4 index [89]. The association of PNPLA3 genotype with incident CVD is conflicting [89][90][91].…”

Distribution of liver stiffness in non‐alcoholic fatty liver disease with higher fibrosis‐4 index than low cut‐off index

“…First, we did not further assess the patients with FIB‐4 index values lower than the low COI. It is estimated, as mentioned earlier, that 78.5% of Japanese patients with NAFLD have FIB‐4 index values lower than the low COI . However, we could not assess this patient population and, consequently, could not evaluate the sensitivity, specificity, and negative predictive value of the FIB‐4 index for predicting significant liver fibrosis estimated by VCTE.…”

“…It is estimated, as mentioned earlier, that 78.5% of Japanese patients with NAFLD have FIB-4 index values lower than the low COI. 22 However, we could not assess this patient population and, consequently, could not evaluate the sensitivity, specificity, and negative predictive value of the FIB-4 index for predicting significant liver fibrosis estimated by VCTE. Second, we could not exclude liver diseases causing fatty liver other than NAFLD, alcoholic liver disease, chronic hepatitis B, and chronic hepatitis C. Liver diseases of other etiologies, including autoimmune hepatitis, primary biliary cirrhosis, hemochromatosis, Wilson's disease, and α-1-antitrypsin-deficiency-associated liver disease, were not be ruled out, because we focused on identifying NAFLD patients with significant liver fibrosis using only those parameters that are routinely measured in the course of health checkup/clinical follow-up examinations.…”

“…Recently, Wada and Zeniya investigated the distribution of the FIB-4 index in a total of 1745 Japanese patients with NAFLD who were detected as having fatty liver at comprehensive general health checkups. 22 They applied the low COI of 1.3 and high COI of 2.67 and reported that 78.5% of the patients had an FIB-4 index of less than the low COI, 20.5% had intermediate values between LSM, liver stiffness measurement; NAFLD, non-alcoholic fatty liver disease; PPV, positive predictive value; VCTE, vibration controlled transient elastography. the low COI and high COI, and only 1% had a higher value than the high COI.…”

Speculation of the Time-Dependent Change of FIB4 Index in Patients with Nonalcoholic Fatty Liver Disease: A Retrospective Study

“…As for the main correlations, the mean absolute rate per year was 0.1371 ± 0.1147 ( Table 2 ). In this viewpoint, since the difference of FIB4 index between 1.30 and 2.67 [ 14 , 27 ] is 1.37, it would take about 10 years by the mean absolute rate per year.…”