A prospective 5-year study on the use of transient elastography to monitor the improvement of non-alcoholic fatty liver disease following bariatric surgery

Liu, Shirley Yuk‐Wah; Wong, Vincent Wai‐Sun; Wong, SK; Wong, Grace Lai–Hung; Lai, Carol Man-Sze; Lam, Candice C.; Shu, Sally She‐Ting; Chan, Henry Lik‐Yuen; Ng, Enders K.

doi:10.1038/s41598-021-83782-0

Cited by 15 publications

(13 citation statements)

References 46 publications

(45 reference statements)

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“…With newer models, liver fibrosis can now be measured by liver stiffness measurement (LSM), and liver steatosis can be measured by controlled attenuation parameter (CAP) [ 66 ]. There are several benefits of TE, including its low cost, fast procedure time, immediate result availability, good reproducibility, and ability to be performed in an outpatient setting [ 67 ]. Several cross-sectional studies have investigated how it helps diagnose NAFLD and assess its severity [ 63 , 65 , 68 ].…”

Section: Discussionmentioning

confidence: 99%

The triglyceride glucose-body mass index: a non-invasive index that identifies non-alcoholic fatty liver disease in the general Japanese population

Han

Cao³

et al. 2022

J Transl Med

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Background By identifying individuals at high risk for non-alcoholic fatty liver disease (NAFLD), interventional programs could be targeted more effectively. Some studies have demonstrated that triglyceride glucose-body mass index (TyG-BMI) showed an independent positive association with NAFLD. However, research on its diagnostic value in patients with suspected NAFLD is limited. In this study, we aimed to evaluate whether TyG-BMI was accurate in detecting NAFLD in the general Japanese population. Methods A cross-sectional study of 14,280 individuals who underwent a comprehensive health examination was conducted. Standard protocols were followed to collect anthropometric measurements, lab data, and ultrasonography features. All participants were randomly stratified into the development group (n = 7118) and validation group (n = 7162). The TyG-BMI was calculated. Following this, the diagnostic value of the TyG-BMI was evaluated based on the area under the receiver-operating characteristic curve (AUROC). Two cutoff points were selected and used to rule out or rule in the NALFD, and the specificity, sensitivity, negative predictive value, and positive predictive value were explored, respectively. In order to verify the stability of the results, external verification was performed. Results There were 1272 and 1243 NAFLD participants in the development and validation groups, respectively. The area under the ROC curve (AUC) of TyG-BMI was 0.888 (95% CI 0.876–0.896) and 0.884 (95% CI 0.875–0.894) for the training and validation group, respectively. Using the low TyG-BMI (182.2) cutoff, NAFLD could be excluded with high accuracy (negative predictive value: 96.9% in estimation and 96.9% in validation). The presence of NAFLD could effectively be determined by applying the high cutoff of TyG-BMI (224.0), as the positive predictive value of the estimation and validation groups is 70.7% and 70.1%, respectively. As a result of applying this model, 9996 (70%) of the 14,280 participants would not have undergone ultrasonography, with an accurate prediction of 9308 (93.1%). AUC was 0.874 for external validation using 183,730 Chinese non-obese participants. TyG-BMI was demonstrated to be an excellent diagnostic tool by both internal and external validation. Conclusions In conclusion, the present study developed and validated a simple, non-invasive, and cost-effective tool to accurately separate participants with and without NAFLD in the Japanese population, rendering ultrasonography for identifying NAFLD unnecessary in a substantial proportion of people.

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Section: Discussionmentioning

confidence: 99%

The triglyceride glucose-body mass index: a non-invasive index that identifies non-alcoholic fatty liver disease in the general Japanese population

Han

Cao³

et al. 2022

J Transl Med

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“…In addition, a long‐term follow‐up study of 102 obese Japanese patients undergoing bariatric surgery demonstrated that liver fat accumulation and visceral fat areas were significantly improved at 1 year after surgery, and the decrease in BMI, body fat percentage, and basal metabolic rate prolonged for at least 5 years 147 . In 37 Asian patients receiving annual TE following bariatric surgery, the mean LSM reduced significantly from baseline values of 9.8‐6.8 kPa at 5 years after operation 148 . The latest APASL guidelines recommend that bariatric surgery can be considered for NAFLD only if the following are met: (a) presence of other indications such as BMI > 30 kg/m 2 (for Asian people) and (b) absence of cirrhosis with high perioperative risk 27 …”

Section: Assessment and Management Of Nafldmentioning

confidence: 99%

Changing clinical management of NAFLD in Asia

Nakatsuka

Tateishi

Koike

2021

Liver International

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Non-alcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease, affecting approximately 25% of the world's population. Recently, because of the sedentary lifestyle and overnutrition resulting from urbanisation, the burden of NAFLD has rapidly increased in many Asian countries. Currently, the prevalence of NAFLD in Asia is approximately 30%, as is the case in many Western countries. In Asia, the prevalence and presentation of NAFLD vary widely across regions because of the substantial diversity in race, socioeconomic status and living environment. Furthermore, the dual aetiology of fatty liver, particularly with viral hepatitis in Asia, makes it complex and challenging to manage. Because Asians are likely to have central adiposity and insulin resistance, approximately 7%-20% of non-obese Asians with body mass indexes of less than 25 kg/m 2 are estimated to have NAFLD.Accumulating evidence indicates that NAFLD is associated with various extrahepatic comorbidities such as cardiovascular disease, chronic kidney disease, malignancy, in addition to liver-specific complications. Therefore, NAFLD should be managed as a multisystem disease in conjunction with metabolic syndrome. Lifestyle modification remains the basis of NAFLD management, but few patients can achieve adequate weight loss and maintain it long term. While various pharmacological agents are in phase 3 trials for steatohepatitis, Asian patients are underrepresented in most trials.

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“…38,39 Furthermore, in recent years, liver stiffness measurement (LSM) by transient elastography (TE) is considered as one of the most relevant lines of investigation with respect to the non-invasive screening of hepatic fibrosis. [40][41][42] As a result, several scoring systems based on the combination of TE with other clinical and/or laboratory parameters have been proposed to improve diagnostic accuracy for fibrosis staging.…”

Section: Introductionmentioning

confidence: 99%

“…44,45 In this context, there is increasing evidence suggesting that NITs for fibrosis could be used as important predictors of long-term clinical outcomes. 39,41,42,46,47 The question as to whether laboratory-and/or imaging-based NIT scores reflecting severity of hepatic fibrosis could be associated with the burden of NAFLD from the patient's perspective is not fully investigated. By taking advantage of the Global NAFLD/ NASH Registry and focusing on the NIT and PRO data collected from patients with NAFLD in Turkey, this registry-based, cross-sectional study assessed the association of PROs with select NITs for fibrosis including FAST, Agile 3+ and Agile 4 scores.…”

Section: Introductionmentioning

confidence: 99%

“…While there is no single non‐invasive test (NIT) that would be clearly superior to all others, one of the most widely used NITs for fibrosis, the fibrosis‐4 (FIB‐4) index, can be calculated based on four easily available parameters, namely, age, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and platelet count 38,39 . Furthermore, in recent years, liver stiffness measurement (LSM) by transient elastography (TE) is considered as one of the most relevant lines of investigation with respect to the non‐invasive screening of hepatic fibrosis 40–42 . As a result, several scoring systems based on the combination of TE with other clinical and/or laboratory parameters have been proposed to improve diagnostic accuracy for fibrosis staging.…”

Section: Introductionmentioning

confidence: 99%

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Impairment of patient‐reported outcomes among patients with non‐alcoholic fatty liver disease: a registry‐based study

Yılmaz

Toraman

Alp

et al. 2022

Aliment Pharmacol Ther

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Background: Patients with non-alcoholic fatty liver disease (NAFLD) and more advanced fibrosis tend to have more impairment in their health-related quality of life and other patient-reported outcomes (PROs). Aim: To assess the association of PROs with select non-invasive tests (NITs) for fibrosis including FAST, Agile 3+ and Agile 4 scores Methods: We enrolled patients with an established diagnosis of NAFLD who were seen in a tertiary care clinic into the NAFLD/NASH Registry. The FAST, Agile 3+ and Agile 4 scores were calculated using liver stiffness measurements by transient elastography and laboratory parameters. PROs were assessed using FACIT-F, CLDQ-NASH and WPAI instruments (total of 17 domain and summary scores).Results: There were 1509 patients with NAFLD (mean age: 49 ± 11 years, 50% men, 41% employed, 30% advanced fibrosis and 20% cirrhosis). The mean FAST, Agile 3+ and Agile 4 scores were 0.39 ± 0.26, 0.35 ± 0.31 and 0.12 ± 0.23, respectively. Subjects with lower FAST, Agile 3+ and Agile 4 scores had the highest scores in select domains of FACIT-F, CLDQ-NASH and WPAI (p < 0.05 in comparison to subjects with elevated or high-risk NIT scores). Correlations with continuous NITs were significantly negative for Emotional and Functional well-being (FACIT-F), Activity/energy, Systemic symptoms, Worry and total scores (CLDQ-NASH), and Activity of WPAI (p < 0.05); the strongest was for Worry (CLDQ-NASH) with FAST (R = −0.17, p < 0.0001). The PRO scores of patients with NAFLD were lower than those of matched patients with chronic hepatitis B (p < 0.05 for 9/17 domain and summary scores). Conclusion:Patients with NAFLD and high FAST, Agile 3+ or Agile 4 scores experience impairment of health-related quality of life.

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A prospective 5-year study on the use of transient elastography to monitor the improvement of non-alcoholic fatty liver disease following bariatric surgery

Cited by 15 publications

References 46 publications

The triglyceride glucose-body mass index: a non-invasive index that identifies non-alcoholic fatty liver disease in the general Japanese population

The triglyceride glucose-body mass index: a non-invasive index that identifies non-alcoholic fatty liver disease in the general Japanese population

Changing clinical management of NAFLD in Asia

Impairment of patient‐reported outcomes among patients with non‐alcoholic fatty liver disease: a registry‐based study

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