The inverse effect of meal intake on controlled attenuation parameter and liver stiffness as assessed by transient elastography

Abstract

BackgroundControlled attenuation parameter (CAP) and liver stiffness (LS) measured by transient elastography (TE, Fibroscan®) have been used for steatosis and fibrosis assessment. We evaluated the effect of meal intake on CAP and LS values.MethodsForty patients who had had a liver biopsy within the previous month were recruited. The biopsy was graded for fibrosis (F) and steatosis (S) stagings. TE was performed after overnight fasting (baseline values) and 15, 30, 45, 60, 90, and 120 min following the intake of a standard commercial formula meal, and every 30 min until LS and CAP values returned to baseline. The effect of meal intake on CAP and LS values was analyzed with a multilevel mixed model approach. ResultsThe mean age was 53.1 ± 11.2 years old. The mean (SD) BMI was 25.6 ± 4.5 kg/m2. F0, F1, F2, F3 and F4 fibrosis stages were found in 17 (42.5%), 9 (22.5%), 4 (10.0%), 8 (20.0%) and 2 (5.0%), respectively. S0, S1, S2 and S3 steatosis stages were seen in 22 (55.0%), 11 (27.5%), 4 (10.0%) and 3 (7.5%), respectively. The mean (SD) CAP and median (IQR) LS values at baseline were 249.7 ± 58.1 dB/m and 11.9 (6–18.1) kPa. A significant decrease in CAP values was observed in all patients 15 to 120 min after meals, with the CAP peak value at 60 min and the mean post-meal delta reduction of 18.1 dB/min. CAP values declined after meals at early fibrosis stages and across all stages of steatosis. A significant increase in LS values after meal intake was observed within 15 to 120 min, with the LS peak value at 15 min and the mean post-meal delta increase of 2.4 kPa. Post-meal CAP and LS values returned to baseline within 150 min following meals.ConclusionFollowing a meal, patients’ CAP values declined with the peak value at 60 min, contrasting with the rising of LS values with the peak value at 15 min. The post-meal CAP and LS values returned to baseline by 150 min. A fasting period of more than 150 min after a meal is recommended for patients undergoing TE.

Effect of Meal Ingestion on Liver Stiffness and Controlled Attenuation Parameter

“…We have not found the same effect of meal intake on CAP values. 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 post-meal 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].…”

“…In the study by Ratchatasettakul et al [20], a significant decline of CAP values following meal intake was observed at 15–120 min. We have not found the same effect of meal intake on CAP values.…”

“…We excluded from the study individuals in whom the fibroscan was not able to obtain results with accuracy (e.g., those having congestive heart failure, pregnancy, ascites, hepatitis, and/or cholestasis jaundice [aspartate aminotransferase or alanine aminotransferase >five times the upper normal, total bilirubin > 5 mg/dL]) [20]. …”

“…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]. …”

“…Similarly, the effect of food intake on CAP is not yet clear. In the study by Ratchatasettakul et al [20], the CAP values were significantly reduced after a liquid meal intake (15–120 min), returning to the fasting levels 150 min later.…”