Preperitoneal fat as a non‐invasive marker of increased risk of severe non‐alcoholic fatty liver disease in patients with type 2 diabetes

Parente, Daniella Braz; Neto, Jaime Araújo Oliveira; Brasil, Pedro Emmanuel Alvarenga Americano do; Paiva, Fernando Fernandes; Ravani, José Pedro Rodrigues; Gomes, Marı́lia B.; Lanzoni, Valéria Pereira; Campos, Carlos Frederico Ferreira; Machado-Silva, Lilian; Perez, Renata M.; Rodrigues, Rosana Souza

doi:10.1111/jgh.13903

Cited by 20 publications

(12 citation statements)

References 45 publications

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“…Conversely, Parente et al concluded that there was no correlation between the subcutaneous fat thickness and the grade of steatosis among type 2 diabetic obese individuals,25 and this result is in accordance with other previous studies which suggested that visceral fat, not subcutaneous fat, is a reliable predictor of NAFLD 26,27…”

Section: Discussionsupporting

confidence: 78%

<p>Abdominal subcutaneous fat thickness and homeostasis model assessment of insulin resistance as simple predictors of nonalcoholic steatohepatitis</p>

Hegazy

Samy²,

Tawfik³

et al. 2019

DMSO

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Background: Obesity, insulin resistance, and diabetes are major risk factors for nonalcoholic fatty liver disease (NAFLD). This study aims to evaluate the association between different grades of NAFLD and abdominal subcutaneous fat thickness with the homeostasis model assessment of insulin resistance (HOMA-IR). Methods: In this pilot study, 59 obese nondiabetic participants with NAFLD were enrolled. Total cholesterol, Hb A1c , and HOMA-IR were measured. Abdominal subcutaneous fat thickness in the midline just below the xiphoid process in front of the left lobe of the liver (LSFT) and in the umbilical region (USFT), and the degree of hepatic steatosis, were evaluated by ultrasound scans, and their correlation with the degree of steatosis and the NAFLD Activity Score in liver biopsy was assessed. Results: Of the 59 studied participants, 15 had mild, 17 had moderate, and 27 had severe hepatic steatosis by abdominal ultrasound. The mean ± SD HOMA-IR level in NAFLD patients was 5.41±2.70. The severity of hepatic steatosis positively correlated with body mass index ( P <0.001), HOMA-IR ( P< 0.001), serum triglycerides ( P =0.001), LSFT ( P <0.001), and USFT ( P <0.001). Receiver operating characteristics analysis showed that LSFT at a cut-off of 3.45 cm is the most accurate predictor of severe hepatic steatosis, with 74.1% sensitivity and 84.4% specificity. The best cut-off of USFT for identifying severe hepatic steatosis is 4.55 cm, with 63% sensitivity and 81.3% specificity. Conclusion: Abdominal subcutaneous fat thicknesses in front of the left lobe of the liver and in the umbilical region, together with HOMA-IR, are reliable indicators of the severity of NAFLD in obese nondiabetic individuals.

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Section: Discussionsupporting

confidence: 78%

<p>Abdominal subcutaneous fat thickness and homeostasis model assessment of insulin resistance as simple predictors of nonalcoholic steatohepatitis</p>

Hegazy

Samy²,

Tawfik³

et al. 2019

DMSO

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“…For cT1 as well, an optimal cut‐off (875 ms) has been suggested, but to distinguish between low‐ and high‐risk (NASH or fibrosis > 1) patients, with sensitivity/specificity of 97%/50%. Other MRI approaches include quantitative susceptibility imaging, intravoxel incoherent motion (IVIM) diffusion‐weighted MRI, and morphological evaluation such as liver volume and preperitoneal fat area, all evaluated in one single study, with AUROCs ranging from 0.61/0.68/0.74 for different IVIM parameters to 0.91 for susceptibility, the last one tested in a small sample of 32 patients. Moreover, a score based on MRI optical analysis estimators produced an AUROC of 0.83 with sensitivity/specificity of 87%/60% .…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, US scores mostly evaluating liver hyperechogenicity present high referral rates and low positive predictive values to obtain high sensitivity. Preperitoneal fat area and perihepatic adipose tissue thickness, evaluated by means of MRI and US, likewise showed high sensitivities and relatively low specificities at the proposed thresholds. Indeed, these are not direct measures of inflammation but rather indicators of visceral adiposity.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of imaging methods for steatohepatitis diagnosis in non‐alcoholic fatty liver disease patients: A systematic review

Besutti

Valenti

Ligabue

et al. 2019

Liver International

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Abbreviations: ARFI, acoustic radiation force impulse; AUROC, area under the receiving operating characteristic curve; MRE, magnetic resonance elastography; MRS, magnetic resonance spectroscopy; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; PDFF, proton density fat fraction; QUADAS-2, Quality Assessment of Diagnostic Accuracy Studies-2; SPIO/USPIO, superparamagnetic iron oxide/ultrasmall superparamagnetic iron oxide; TE, transient elastography. AbstractBackground & Aims: Non-invasive tests to diagnose non-alcoholic steatohepatitis (NASH) are urgently needed. This systematic review aims to evaluate imaging accuracy in diagnosing NASH among non-alcoholic fatty liver disease (NAFLD) patients, using liver biopsy as reference.Methods: Eligible studies were systematic reviews and cross-sectional/cohort studies of NAFLD patients comparing imaging with histology, considering accuracy and/ or associations. MEDLINE, Scopus, EMBASE and Cochrane Library databases were searched up to April 2018. Studies were screened on title/abstract, then assessed for eligibility on full-text. Data were extracted using a predesigned form. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 tool. Results:Of the 641 studies screened, 61 were included in scoping review, 30 of which (with accuracy results) in data synthesis. Imaging techniques included: elastography (transient elastography-TE, acoustic radiation force impulse-ARFI, magnetic resonance elastography-MRE), ultrasound (US), magnetic resonance (MR), computed tomography and scintigraphy. Histological NASH definition was heterogeneous. In 28/30 studies, no prespecified threshold was used (high risk of bias). AUROCs were up to 0.82 for TE, 0.90 for ARFI, 0.93 for MRE and 0.82 for US scores. MR techniques with higher accuracy were spectroscopy (AUROC = 1 for alanine), susceptibility-weighted imaging (AUROC = 0.91), multiparametric MR (AUROC = 0.80), optical analysis (AUROC = 0.83), gadoxetic acid-enhanced MR (AUROCs = 0.85) and superparamagnetic iron oxide-enhanced MR (AUROC = 0.87). Results derived mostly from single studies without independent prospective validation. Conclusions:There is currently insufficient evidence to support the use of imaging to diagnose NASH. More studies are needed on US and MR elastography and non-elastographic techniques, to date the most promising methods. K E Y W O R D Smagnetic resonance, non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, ultrasonography

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“…Compared with VAT and SAT, adipose-derived stem/stromal cells derived from pPAT revealed highest capacity to generate new adipocytes by adipogenesis and low proinflammatory profile ( 61 ). Nevertheless, pPAT behaves like VAT and is correlated positively with hypertension, dyslipidemia, insulin resistance, cardiovascular disease risks, and obesity ( 5 , 31 ). Compared with previous research, we found that pPAT area was significantly associated with hypertension, T2DM, high TG, low-HDL-C, CCRFs, and measures of TG and HDL-C independent of BMI in men rather than women.…”

Section: Discussionmentioning

confidence: 99%

“…pPAT was defined as the fat depot anteriorly seen from the anterior surface of the left lobe of the liver to the linea alba ( 31 ). pPAT area and FF were measured using the spline contour region of interest (ROI) method ( Figure 1D ).…”

Section: Methodsmentioning

confidence: 99%

Magnetic Resonance Imaging Assessment of Abdominal Ectopic Fat Deposition in Correlation With Cardiometabolic Risk Factors

et al. 2022

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PurposeEctopic fat accumulation and abdominal fat distribution may have different cardiometabolic risk profiles. This study aimed to assess the associations between various magnetic resonance imaging (MRI)-acquired fat depots and cardiometabolic risk factors.MethodsA total of 320 subjects with median age of 59 years, 148 men and 172 women, were enrolled in the study. Visceral adipose tissue (VAT) area and fat fraction (FF), subcutaneous adipose tissue (SAT) area and FF at the L1–L2 levels, preperitoneal adipose tissue (pPAT) area and FF, hepatic FF, pancreatic FF, and intramuscular FF were assessed by MRI FF maps. The associations of various MRI-acquired fat depots with blood pressure, glucose, and lipid were examined using sex-stratified linear regression. Logistic regression stratified by sex was used to analyze the association of various MRI-acquired fat depots with the risk of hypertension, T2DM, and dyslipidemia.ResultsThe intraclass correlation coefficient (ICC) values were >0.9, which suggested good interobserver and intraobserver agreement. VAT area, V/S, hepatic fat, pancreatic fat, and pPAT rather than SAT area were significantly associated with multiple cardiometabolic risk factors (all p < 0.05). However, the patterns of these correlations varied by sex and specific risk factors. Also, VAT and SAT FF were only significantly associated with multiple cardiometabolic risk factors in women (all p < 0.05).ConclusionsVAT, hepatic fat, pancreatic fat, and pPAT were associated with cardiovascular metabolic risk factors independent of BMI. The patterns of these correlations were related to gender. These findings further the understanding of the association between ectopic fat deposition and cardiometabolic risk factors and help to better understand the obesity heterogeneity.

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Preperitoneal fat as a non‐invasive marker of increased risk of severe non‐alcoholic fatty liver disease in patients with type 2 diabetes

Cited by 20 publications

References 45 publications

<p>Abdominal subcutaneous fat thickness and homeostasis model assessment of insulin resistance as simple predictors of nonalcoholic steatohepatitis</p>

<p>Abdominal subcutaneous fat thickness and homeostasis model assessment of insulin resistance as simple predictors of nonalcoholic steatohepatitis</p>

Accuracy of imaging methods for steatohepatitis diagnosis in non‐alcoholic fatty liver disease patients: A systematic review

Magnetic Resonance Imaging Assessment of Abdominal Ectopic Fat Deposition in Correlation With Cardiometabolic Risk Factors

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