Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study

Kwok, Raymond; Choi, Kai Chow; Wong, Grace Lai–Hung; Zhang, Yuying; Chan, Henry Lik-Yuen; Luk, Andrea O. Y.; Shu, Sally She‐Ting; Chan, Anthony Wing–Hung; Yeung, Ming Wai; Chan, Juliana C.N.; Kong, Alice Pik‐Shan; Wong, Vincent Wai‐Sun

doi:10.1136/gutjnl-2015-309265

Cited by 417 publications

(406 citation statements)

References 40 publications

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“…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]. …”

Section: Methodsmentioning

confidence: 99%

Effect of Meal Ingestion on Liver Stiffness and Controlled Attenuation Parameter

Silva

Moreira

Peixoto

et al. 2018

GE Port J Gastroenterol

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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.

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Section: Methodsmentioning

confidence: 99%

Effect of Meal Ingestion on Liver Stiffness and Controlled Attenuation Parameter

Silva

Moreira

Peixoto

et al. 2018

GE Port J Gastroenterol

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“…It is referred to as the hepatic manifestation of the metabolic syndrome and has now become the most common liver disease affecting an estimated one-third of adults in the general population of developed countries 3. In high-risk populations with type 2 diabetes and metabolic comorbidities, prevalence of NAFLD even reaches up to 70% 4. Progression of NAFLD can lead to fibrosis, cirrhosis, hepatocellular carcinoma and liver failure with corresponding life-threatening complications.…”

Section: Introductionmentioning

confidence: 99%

Association of dietary macronutrient composition and non-alcoholic fatty liver disease in an ageing population: the Rotterdam Study

Alferink

Jong

Erler

et al. 2018

Gut

105

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ObjectiveA healthy lifestyle is the first-line treatment in non-alcoholic fatty liver disease (NAFLD), but specific dietary recommendations are lacking. Therefore, we aimed to determine whether dietary macronutrient composition is associated with NAFLD.DesignParticipants from the Rotterdam Study were assessed on (1) average intake of macronutrients (protein, carbohydrate, fat, fibre) using a Food Frequency Questionnaire and (2) NAFLD presence using ultrasonography, in absence of excessive alcohol, steatogenic drugs and viral hepatitis. Macronutrients were analysed using the nutrient density method and ranked (Q1–Q4). Logistic regression analyses were adjusted for sociodemographic, lifestyle and metabolic covariates. Moreover, analyses were adjusted for and stratified by body mass index (BMI) (25 kg/m2). Also, substitution models were built.ResultsIn total, 3882 participants were included (age 70±9, 58% female). NAFLD was present in 1337 (34%) participants of whom 132 were lean and 1205 overweight. Total protein was associated with overweight NAFLD after adjustment for sociodemographic and lifestyle covariates (ORQ4vsQ1 1.40; 95% CI 1.11 to 1.77). This association was driven by animal protein (ORQ4vsQ1 1.54; 95% CI 1.20 to 1.98). After adjustment for metabolic covariates, only animal protein remained associated with overweight NAFLD (ORQ4vsQ1 1.36; 95% CI 1.05 to 1.77). Monosaccharides and disaccharides were associated with lower overall NAFLD prevalence (ORQ4vsQ1 0.66; 95% CI 0.52 to 0.83) but this effect diminished after adjustment for metabolic covariates and BMI. No consistent associations were observed for fat subtypes or fibre. There were no substitution effects.ConclusionThis large population-based study shows that high animal protein intake is associated with NAFLD in overweight, predominantly aged Caucasians, independently of well-known risk factors. Contrary to previous literature, our results do not support a harmful association of monosaccharides and disaccharides with NAFLD.

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“…Transient elastography (TE), suggested for population-wide screens (eg, patients with diabetes),5 requires additional expensive devices and trained personnel. However, contrast-enhanced MRI is routinely performed and recommended in patients with CLD for exclusion of hepatocellular carcinoma (HCC) and other malignancies 6.…”

mentioning

confidence: 99%

Quantitative liver MRI including extracellular volume fraction for non-invasive quantification of liver fibrosis: a prospective proof-of-concept study

Luetkens

Klein

Traeber

et al. 2017

Gut

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Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study

Abstract: Diabetic patients have a high prevalence of NAFLD and advanced fibrosis. Those with obesity and dyslipidaemia are at particularly high risk and may be the target for liver assessment. Our data support screening for NAFLD and/or advanced fibrosis in patients with type 2 diabetes.

Cited by 417 publications

References 40 publications

Effect of Meal Ingestion on Liver Stiffness and Controlled Attenuation Parameter

Effect of Meal Ingestion on Liver Stiffness and Controlled Attenuation Parameter

Association of dietary macronutrient composition and non-alcoholic fatty liver disease in an ageing population: the Rotterdam Study

Quantitative liver MRI including extracellular volume fraction for non-invasive quantification of liver fibrosis: a prospective proof-of-concept study

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