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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Estimation of visceral fat is useful for the diagnosis of significant fibrosis in patients with non-alcoholic fatty liver disease
Marta Hernández-Conde, Elba Llop, Carlos Fernández Carrillo, Beatriz Tormo, Javier Abad, Luis Rodriguez, Christie Perelló, Marta López Gomez, José Luis Martínez-Porras, Natalia Fernández Puga, Maria Trapero-Marugan, Enrique Fraga, Carlos Ferre Aracil, José Luis Calleja Panero
Marta Hernández-Conde, Elba Llop, Carlos Fernández Carrillo, Beatriz Tormo, Javier Abad, Luis Rodriguez, Christie Perelló, Marta López Gomez, José Luis Martínez-Porras, Natalia Fernández Puga, Maria Trapero-Marugan, Enrique Fraga, Carlos Ferre Aracil, José Luis Calleja Panero, Gastroenterology and Hepatology Department, IDIPHISA, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid 28222, Spain
Elba Llop, Carlos Fernández Carrillo, Maria Trapero-Marugan, Enrique Fraga, José Luis Calleja Panero, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas, Instituto de Salud Carlos III, Madrid 28029, Spain
Author contributions: Hernández-Conde M contributed to study concept and design, acquisition of data, statistical analysis and interpretation of data; manuscript preparation; Llop E contributed to study concept and design, statistical analysis and interpretation of data; critical discussion and support; Fernández Carrillo C contributed to critical discussion and support; Tormo B, Abad J, Rodríguez L, Perelló C, López-Gómez M, Martínez-Porras JL, Fernández-Puga N, Trapero M, Fraga E and Ferre C contributed to acquisition of data; Calleja Panero JL contributed to concept and design, analysis and interpretation of data, manuscript preparation, final drafting of the manuscript and study supervision.
Institutional review board statement: The protocol was approved by the Ethics Committee of the Hospital Universitario Puerta de Hierro-Majadahonda (PI 05-18, 12/03/2018) and it was conducted according to the 1975 Declaration of Helsinki and the Good Clinical Practice guidelines.
Informed consent statement: Written informed consent was obtained from all patients prior to inclusion.
Conflict-of-interest statement: The authors have no conflicts of interest relevant to this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: José Luis Calleja Panero, PhD, Chairman, Chief Doctor, Senior Researcher, Gastroenterology and Hepatology Department, IDIPHISA, Hospital Universitario Puerta de Hierro-Majadahonda, C/Joaquín Rodrigo, 2, Madrid 28222, Spain.
joseluis.calleja@uam.es
Received: September 5, 2020
Peer-review started: September 5, 2020
First decision: September 30, 2020
Revised: October 9, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: November 14, 2020
Processing time: 68 Days and 15.2 Hours
BACKGROUND
Obesity is a risk factor for non-alcoholic fatty liver disease (NAFLD), although obese patients with NAFLD do not always develop significant fibrosis. The distribution of body fat could predict the risk of NAFLD progression.
AIM
To investigate the role of bioelectrical impedance-estimated visceral fat (VF) in assessing NAFLD severity.
METHODS
In this cross-sectional study, patients with biopsy-proven NAFLD were prospectively included. All patients underwent anthropometric evaluation, blood tests and bioelectrical impedance analysis.
RESULTS
Between 2017 and 2020, 119 patients were included [66.4% male, 56 years (SD 10.7), 62.2% obese, 61.3% with metabolic syndrome]. Sixty of them (50.4%) showed significant fibrosis (≥ F2) in liver biopsy. Age, VF and metabolic syndrome were associated with significant fibrosis (61 years vs 52 years, 16.4 vs 13.1, 73.3% vs 49.2%, respectively; P < 0.001 for all). In the multivariate analysis, VF and age were independently associated with significant fibrosis (VF, OR: 1.11, 95%CI: 1.02-1.22, P = 0.02; age, OR: 1.08, 95%CI: 1.03-1.12, P < 0.01). A model including these variables showed and area under the receiver operating characteristic curve (AUROC) of 0.75, which was not inferior to transient elastography or NAFLD fibrosis score AUROCs. We developed a nomogram including age and VF for assessing significant fibrosis in routine practice.
CONCLUSION
VF is a surrogate marker of liver fibrosis in patients with NAFLD. Bioelectrical impedance analysis is an inexpensive and simple method that can be combined with age to guide patient referral when other resources may be unavailable.
Core Tip: Obesity is a risk factor for non-alcoholic fatty liver disease (NAFLD), although obese patients with NAFLD do not always develop significant fibrosis. The distribution of body fat could predict the risk of NAFLD progression. Our study demonstrates that bioimpedanciometry-estimated visceral fat is useful for detecting advanced NAFLD. Our proposed simple method would allow referral to specialized care in a wide variety of resource-limited settings. Future studies will aim at validating this tool in larger prospective cohorts.
