Transient Elastography Measures of Hepatic Steatosis and Fibrosis Are Associated With Body Composition Among US Adolescents

Abstract

Objectives: Obesity-related fatty liver disease impacts long-term adolescent liver health. We examined transient elastography assessed hepatic steatosis and fibrosis distributions and relationships with body composition and lifestyle factors in a United States national adolescent population sample. Methods: Liver stiffness and controlled attenuation parameter (CAP) were assessed on 1080 non-Hispanic white, non-Hispanic black, non-Hispanic Asian, and Hispanic boys and girls aged 12-19 years in the National Health and Nutrition Examination Survey (NHANES) 2017-2018. Participants underwent anthropometry and dual-energy x-ray absorptiometry (DXA). Results: Compared with girls, boys had higher mean CAP (223.7 dB/m vs 215.3 dB/m) and liver stiffness (5.1 kPa vs 4.9 kPa). CAP and liver stiffness increased markedly with body mass index (BMI). In multivariable-adjusted analysis, CAP in the upper quartile was associated with Hispanic and non-Hispanic Asian ethnicity and increased BMI, waist-to-hip ratio, systolic blood pressure, and sedentary time, and decreased physical activity and Healthy Eating Index-2015 score. In multivariable-adjusted analysis, liver stiffness in the upper quartile was associated with male sex, non-Hispanic black ethnicity, and increased BMI, alanine aminotransferase, CAP, and serum cotinine. DXA total percent fat and trunk fat percent were positively related to CAP (P < 0.001 for each), but not to liver stiffness with multivariable adjustment. Results were similar with CAP and liver stiffness as continuous characteristics. Conclusions: In US adolescents, increased anthropometric and DXA body composition measures and lifestyle factors were associated with higher CAP and liver stiffness. Transient elastography and similar noninvasive markers may be utilized for early detection of liver disease in high-risk pediatric populations.

Obesity and Body Composition in Relation to Liver and Kidney Ultrasound Elastography in Paediatric Patients with Either Hypertension or Chronic Kidney Disease

“…In adults, a similar study evaluated the association between liver and dual-energy X-ray absorptiometry. The mentioned study showed a similar positive correlation between BC and higher liver stiffness measured with transient elastography in the general population [21].…”

“…Although not reaching statistical significance, correlations within each group indicated an expected trend, which is even more pronounced after BMI division, where lean participants exhibited significant negative correlation. Interestingly, in a similar study, they found that the amount of adipose tissue measured by densitometry was also unrelated to the measurement of liver elasticity itself; however, it was related to other results of transient elastography [21]. Regardless of these inconclusive results that require further investigation, reduced liver elasticity showed an association with MAFLD in overweight/obese participants [5,19] with studies confirming the benefit of liver UE when following up patients with MAFLD among other indications [19,22].…”

Regional fat distribution and hepatic fibrosis and steatosis severity in patients with nonalcoholic fatty liver disease and type 2 diabetes

“…However, we did not find an association between trunk fat mass and severe hepatic steatosis in the patients with T2DM and NAFLD. This discrepancy with the previous studies 32 , 33 could be explained by the fact that during the progression of fibrosis or cirrhosis, steatosis may disappear; this condition is also called burnt‐out non‐alcoholic steatohepatitis (NASH). 34 …”