Effect of Meal Ingestion on Liver Stiffness and Controlled Attenuation Parameter

Abstract

Background and Aims: Despite the increasing use of noninvasive methods for the assessment of liver fibrosis and steatosis, the effect of fasting and food intake on these parameters is not yet clear. Our aims were to evaluate the effect of food intake on liver stiffness (LS) (measured by transient elastography) and controlled attenuation parameter (CAP) in patients with different degrees of liver disease and healthy volunteers, and secondarily, to assess possible factors associated with variations of LS and CAP. Methods: We performed a prospective single-center study including patients with liver disease and healthy volunteers. LS and CAP were evaluated using FibroScan® (Echosens, Paris, France), before (fasting ≥8 h) and 30 min after intake of a standardized breakfast. We used common cutoffs for LS: > 7 kPa for significant fibrosis (F2 to F4) and > 11 to 14 kPa (mean 12.5 kPa) for cirrhosis. Results: Fifty-nine (72%) patients with liver disease and 22 (28%) healthy volunteers were included. LS significantly increased 30 min after food intake (pre-meal 6.1 kPa [IQR: 4.7–9.8] vs. after-meal 6.8 kPa [IQR: 5.5–10.6]; p < 0.001). This difference was only significant in patients with chronic liver disease (p = 0.02) and not in healthy volunteers (p = 0.106). CAP values did not increase significantly after food intake. Gender, body mass index, mass of body fat, lean body mass, and percent of body fat were not related with significant variations of LS and CAP values after meal intake. Conclusions: Significant variations of LS were observed after ingestion of a standard meal, which may have consequences for patient management. CAP values were not significantly affected by food intake. Therefore, we consider that before the isolated evaluation of CAP, it is not necessary to perform any fasting period.

Effect of meal ingestion on liver stiffness and controlled attenuation parameter

“…In our study, we found a significant statistical difference in TE values in patients with chronic liver disease (p = 0.02). These data are in accordance with previous works [16][17][18]. In fact, in the study by Arena et al [17], with a fibrosis stage validated by histology, a higher LS value was found between 15 and 45 min after meal intake in all patients, with more pronounced differences in cirrhotic individuals.…”

“…Also, Dauzat M et al [29] analyzed the volume of blood flow in portal vein after the intake of a fluid meal and showed that the blood flow already increased at 15 min and reached a maximum 30 min after food intake. Berzigotti et al [18] measured LS, portal vein vascular flow, and hepatic artery vascular flow after meal intake in cirrhotic patients. Postprandial hyperemia was accompanied by a marked increase in LS and these differences directly correlated with hepatic artery vascular flow (but surprisingly were not associated with differences in portal vein vascular flow).…”

“…In our study, the timing of the measurements was set at 30 min after meal ingestion, while in the study by Ratchatasettakul et al [20], the CAP postmeal peak was observed 60 min after meal intake. Our time point was chosen according to previous observations indicating that postprandial hyperemia and the postprandial increase of portal pressure were highest 30 min after meal ingestion [18]. Also, contrary to this study and previous studies that have used a liquid meal with 600 kcal as a standardized measure [28,29], in our study, we preferred the adoption of a solid meal with equal caloric load, in order to bring the study conditions closer to realworld practice.…”

“…LS and CAP were evaluated using FibroScan ® (Echosens, Paris, France) before (fasting ≥8 h) and 30 min after intake of a standardized breakfast (milk, coffee, sugar, bread, butter, cookies -with ∼600 kcal). Although the use of only 2-4 h of fasting was described [16,17,21], in our study, an overnight fasting period (nearly 8 h) was used in order to ensure that there was definitively no bias with food ingestion prior to the evaluation, as described in other articles [18,20,22,23].…”

“…On the other hand, high body mass index (BMI), alcohol drinking, F3-4 fibrosis, and histological steatosis grade 3 interfere with the accuracy of CAP measurement [9,15]. Also, previous studies demonstrated that LS assessed by TE was affected by food ingestion from the mechanism of postprandial hyperemia [16][17][18]. Another study demonstrated a significant alteration in LS only in a subgroup of patients with chronic HBV infection without significant fibrosis, and the authors conclud- ed that the absence of fasting would not imply a change in the clinical decision [19].…”