Hypertension and diabetes mellitus are associated with high FIB-4 index in a health checkup examination cohort without known liver disease

Abstract

Background Non-alcoholic fatty liver disease (NAFLD) is usually asymptomatic and lacks a specific biomarker; therefore, many individuals might remain undiagnosed even with advanced liver fibrosis. The aim of this study was to clarify the prevalence and clinical features of subjects with a high risk of advanced liver fibrosis in the general population, using the Fibrosis-4 (FIB-4) index. Methods We retrospectively investigated 6,087 subjects without known liver disease who had participated in an annual health checkup examination. We analyzed the factors associated with high FIB-4 index (≥ 2.67) using a logistic regression analysis. Results Among the 6,087 subjects, 76 (1.2%) had high FIB-4 index. Multivariate analysis identified hypertension (odds ratio [OR]; 9.040; 95% confidence interval [CI], 4.081–20.024; P < 0.001) and diabetes mellitus (OR = 4.251; 95% CI, 1.773–10.193; P = 0.001) as important risk factors for high FIB-4 index. The rates of hypertension and diabetes mellitus in subjects with high FIB-4 index were 78.9% and 23.7%, respectively. No significant association was observed between obesity or large waist circumference and high FIB-4 index. A history of cardiovascular disease was significantly more common in subjects with high FIB-4 index. These results were also observed in subjects with normal liver function test. Conclusions The present study revealed that approximately 1% of the general Japanese population has a high risk of advanced liver fibrosis. Many of these patients had hypertension and/or diabetes mellitus. Our findings suggest that there are many undiagnosed patients NAFLD with risk of advanced liver fibrosis in the general population.

Liver Fibrosis Regression and Associated Factors in HCV Patients Treated with Direct-Acting Antiviral Agents

“…Advanced stage results in longer time before liver tissue healing and may prevent healing altogether; other causes could be related to liver-related comorbidities, particularly if the patients had a combination of liver diseases, such as hepatitis C in combination with hepatitis B infection or fatty liver disease. In addition, other non-liver comorbidities, such as diabetes mellitus, obesity, and metabolic syndrome, could increase the risk for liver fibrosis and could result in the progression of liver fibrosis unrelated to liver disease [ 21 , 22 ].…”

The change in Fibrosis‐4 index in Japanese patients with type 2 diabetes treated by a fixed‐ratio combination therapy of insulin degludec and liraglutide: A retrospective observational study

“…33 The cutoff value of FIB-4 for low-and high-risk liver fibrosis was defined as 1.3 and 2.67, respectively. 22,23 The primary outcome in the present study was the change in FIB-4 during 6 months of observation after the initiation of IDegLira. The secondary outcomes were the changes in the glycated hemoglobin (HbA1c) value and bodyweight, and the AEs.…”

“…15,16 Advanced liver fibrosis is a leading cause of hepatocellular carcinoma (HCC), and may be associated with an increased incidence of HCC in patients with type 2 diabetes. [17][18][19] Because Fibrosis-4 index (FIB-4), a noninvasive evaluation method for liver fibrosis, [20][21][22][23] is the most cost-effective strategy for screening patients with type 2 diabetes in primary care and diabetes clinical settings, the Standard Care in Diabetes-2023 issued by the American Diabetes Association states that adults with type 2 diabetes should be screened/risk-stratified for NAFLD using FIB-4, even if they have normal liver enzyme levels. 24 Since 2019, titratable fixed-ratio combination (FRC) injections containing basal insulin preparation and GLP1-RA have become available in Japan.…”

Association between Major Adverse Cardiovascular Events and the Liver Fibrosis Score in Patients with and without Coronary Artery Disease: From the FU-CCTA Registry

“…There may be a similar relationship between the heart and the liver, through a “cardio-hepatic syndrome” [ 2 , 3 ]. Recently, there have been several reports on the association between hepatic fibrosis and cardiovascular disease including coronary artery disease (CAD) [ 4 , 5 , 6 , 7 , 8 ], although the number of papers is small. A history of cardiovascular disease in 6087 patients without known liver disease who had participated in an annual health checkup examination was significantly more common in subjects with a high fibrosis-4 index (FIB-4I), which is an index of the severity of liver fibrosis [ 4 ].…”

“…Recently, there have been several reports on the association between hepatic fibrosis and cardiovascular disease including coronary artery disease (CAD) [ 4 , 5 , 6 , 7 , 8 ], although the number of papers is small. A history of cardiovascular disease in 6087 patients without known liver disease who had participated in an annual health checkup examination was significantly more common in subjects with a high fibrosis-4 index (FIB-4I), which is an index of the severity of liver fibrosis [ 4 ]. FIB4-I is closely associated with CAD in type 2 diabetes mellitus (DM) [ 5 ] and in metabolic-associated fatty liver disease [ 6 ].…”