Sequential algorithm to stratify liver fibrosis risk in overweight/obese metabolic dysfunction-associated fatty liver disease
BackgroundNon-diabetic overweight/obese metabolic dysfunction-associated fatty liver disease (MAFLD) represents the largest subgroup with heterogeneous liver fibrosis risk. Metabolic dysfunction promotes liver fibrosis. Here, we investigated whether incorporating additional metabolic risk factors in...
| Main Authors: | , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-01-01
|
| Series: | Frontiers in Endocrinology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2022.1056562/full |
| _version_ | 1828070462996873216 |
|---|---|
| author | Chi-Ho Lee Chi-Ho Lee David Tak-Wai Lui Raymond Hang-Wun Li Michele Mae-Ann Yuen Carol Ho-Yi Fong Ambrose Pak-Wah Leung Justin Chiu-Man Chu Loey Lung-Yi Mak Tai-Hing Lam Jean Woo Yu-Cho Woo Aimin Xu Aimin Xu Hung-Fat Tse Kathryn Choon-Beng Tan Bernard Man-Yung Cheung Man-Fung Yuen Man-Fung Yuen Karen Siu-Ling Lam Karen Siu-Ling Lam |
| author_facet | Chi-Ho Lee Chi-Ho Lee David Tak-Wai Lui Raymond Hang-Wun Li Michele Mae-Ann Yuen Carol Ho-Yi Fong Ambrose Pak-Wah Leung Justin Chiu-Man Chu Loey Lung-Yi Mak Tai-Hing Lam Jean Woo Yu-Cho Woo Aimin Xu Aimin Xu Hung-Fat Tse Kathryn Choon-Beng Tan Bernard Man-Yung Cheung Man-Fung Yuen Man-Fung Yuen Karen Siu-Ling Lam Karen Siu-Ling Lam |
| author_sort | Chi-Ho Lee |
| collection | DOAJ |
| description | BackgroundNon-diabetic overweight/obese metabolic dysfunction-associated fatty liver disease (MAFLD) represents the largest subgroup with heterogeneous liver fibrosis risk. Metabolic dysfunction promotes liver fibrosis. Here, we investigated whether incorporating additional metabolic risk factors into clinical evaluation improved liver fibrosis risk stratification among individuals with non-diabetic overweight/obese MAFLD.Materials and methodsComprehensive metabolic evaluation including 75-gram oral glucose tolerance test was performed in over 1000 participants from the New Hong Kong Cardiovascular Risk Factor Prevalence Study (HK-NCRISPS), a contemporary population-based study of HK Chinese. Hepatic steatosis and fibrosis were evaluated based on controlled attenuation parameter and liver stiffness (LS) measured using vibration-controlled transient elastography, respectively. Clinically significant liver fibrosis was defined as LS ≥8.0 kPa. Our findings were validated in an independent pooled cohort comprising individuals with obesity and/or polycystic ovarian syndrome.ResultsOf the 1020 recruited community-dwelling individuals, 312 (30.6%) had non-diabetic overweight/obese MAFLD. Among them, 6.4% had LS ≥8.0 kPa. In multivariable stepwise logistic regression analysis, abnormal serum aspartate aminotransferase (AST) (OR 7.95, p<0.001) and homeostasis model assessment of insulin resistance (HOMA-IR) ≥2.5 (OR 5.01, p=0.008) were independently associated with LS ≥8.0 kPa, in a model also consisting of other metabolic risk factors including central adiposity, hypertension, dyslipidaemia and prediabetes. A sequential screening algorithm using abnormal AST, followed by elevated HOMA-IR, was developed to identify individuals with LS ≥8.0 kPa, and externally validated with satisfactory sensitivity (>80%) and negative predictive value (>90%).ConclusionA sequential algorithm incorporating AST and HOMA-IR levels improves fibrosis risk stratification among non-diabetic overweight/obese MAFLD individuals. |
| first_indexed | 2024-04-11T00:38:10Z |
| format | Article |
| id | doaj.art-7939c6218d83411dab2c3d8f16daaec8 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-04-11T00:38:10Z |
| publishDate | 2023-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-7939c6218d83411dab2c3d8f16daaec82023-01-06T14:49:47ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922023-01-011310.3389/fendo.2022.10565621056562Sequential algorithm to stratify liver fibrosis risk in overweight/obese metabolic dysfunction-associated fatty liver diseaseChi-Ho Lee0Chi-Ho Lee1David Tak-Wai Lui2Raymond Hang-Wun Li3Michele Mae-Ann Yuen4Carol Ho-Yi Fong5Ambrose Pak-Wah Leung6Justin Chiu-Man Chu7Loey Lung-Yi Mak8Tai-Hing Lam9Jean Woo10Yu-Cho Woo11Aimin Xu12Aimin Xu13Hung-Fat Tse14Kathryn Choon-Beng Tan15Bernard Man-Yung Cheung16Man-Fung Yuen17Man-Fung Yuen18Karen Siu-Ling Lam19Karen Siu-Ling Lam20Department of Medicine, School of Clinical Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, ChinaState Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine, School of Clinical Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, ChinaDepartment of Obstetrics and Gynaecology, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine, School of Clinical Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine, School of Clinical Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine, School of Clinical Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine, School of Clinical Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine, School of Clinical Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, ChinaThe School of Public Health, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine, School of Clinical Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine, School of Clinical Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, ChinaState Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine, School of Clinical Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine, School of Clinical Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine, School of Clinical Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine, School of Clinical Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, ChinaState Key Laboratory of Liver Research, University of Hong Kong, Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine, School of Clinical Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong SAR, ChinaState Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong, Hong Kong SAR, ChinaBackgroundNon-diabetic overweight/obese metabolic dysfunction-associated fatty liver disease (MAFLD) represents the largest subgroup with heterogeneous liver fibrosis risk. Metabolic dysfunction promotes liver fibrosis. Here, we investigated whether incorporating additional metabolic risk factors into clinical evaluation improved liver fibrosis risk stratification among individuals with non-diabetic overweight/obese MAFLD.Materials and methodsComprehensive metabolic evaluation including 75-gram oral glucose tolerance test was performed in over 1000 participants from the New Hong Kong Cardiovascular Risk Factor Prevalence Study (HK-NCRISPS), a contemporary population-based study of HK Chinese. Hepatic steatosis and fibrosis were evaluated based on controlled attenuation parameter and liver stiffness (LS) measured using vibration-controlled transient elastography, respectively. Clinically significant liver fibrosis was defined as LS ≥8.0 kPa. Our findings were validated in an independent pooled cohort comprising individuals with obesity and/or polycystic ovarian syndrome.ResultsOf the 1020 recruited community-dwelling individuals, 312 (30.6%) had non-diabetic overweight/obese MAFLD. Among them, 6.4% had LS ≥8.0 kPa. In multivariable stepwise logistic regression analysis, abnormal serum aspartate aminotransferase (AST) (OR 7.95, p<0.001) and homeostasis model assessment of insulin resistance (HOMA-IR) ≥2.5 (OR 5.01, p=0.008) were independently associated with LS ≥8.0 kPa, in a model also consisting of other metabolic risk factors including central adiposity, hypertension, dyslipidaemia and prediabetes. A sequential screening algorithm using abnormal AST, followed by elevated HOMA-IR, was developed to identify individuals with LS ≥8.0 kPa, and externally validated with satisfactory sensitivity (>80%) and negative predictive value (>90%).ConclusionA sequential algorithm incorporating AST and HOMA-IR levels improves fibrosis risk stratification among non-diabetic overweight/obese MAFLD individuals.https://www.frontiersin.org/articles/10.3389/fendo.2022.1056562/fullobesityMAFLD (metabolic associated fatty liver disease)overweightfatty liver diseasepopulation based study |
| spellingShingle | Chi-Ho Lee Chi-Ho Lee David Tak-Wai Lui Raymond Hang-Wun Li Michele Mae-Ann Yuen Carol Ho-Yi Fong Ambrose Pak-Wah Leung Justin Chiu-Man Chu Loey Lung-Yi Mak Tai-Hing Lam Jean Woo Yu-Cho Woo Aimin Xu Aimin Xu Hung-Fat Tse Kathryn Choon-Beng Tan Bernard Man-Yung Cheung Man-Fung Yuen Man-Fung Yuen Karen Siu-Ling Lam Karen Siu-Ling Lam Sequential algorithm to stratify liver fibrosis risk in overweight/obese metabolic dysfunction-associated fatty liver disease Frontiers in Endocrinology obesity MAFLD (metabolic associated fatty liver disease) overweight fatty liver disease population based study |
| title | Sequential algorithm to stratify liver fibrosis risk in overweight/obese metabolic dysfunction-associated fatty liver disease |
| title_full | Sequential algorithm to stratify liver fibrosis risk in overweight/obese metabolic dysfunction-associated fatty liver disease |
| title_fullStr | Sequential algorithm to stratify liver fibrosis risk in overweight/obese metabolic dysfunction-associated fatty liver disease |
| title_full_unstemmed | Sequential algorithm to stratify liver fibrosis risk in overweight/obese metabolic dysfunction-associated fatty liver disease |
| title_short | Sequential algorithm to stratify liver fibrosis risk in overweight/obese metabolic dysfunction-associated fatty liver disease |
| title_sort | sequential algorithm to stratify liver fibrosis risk in overweight obese metabolic dysfunction associated fatty liver disease |
| topic | obesity MAFLD (metabolic associated fatty liver disease) overweight fatty liver disease population based study |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2022.1056562/full |
| work_keys_str_mv | AT chiholee sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT chiholee sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT davidtakwailui sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT raymondhangwunli sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT michelemaeannyuen sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT carolhoyifong sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT ambrosepakwahleung sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT justinchiumanchu sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT loeylungyimak sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT taihinglam sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT jeanwoo sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT yuchowoo sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT aiminxu sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT aiminxu sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT hungfattse sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT kathrynchoonbengtan sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT bernardmanyungcheung sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT manfungyuen sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT manfungyuen sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT karensiulinglam sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease AT karensiulinglam sequentialalgorithmtostratifyliverfibrosisriskinoverweightobesemetabolicdysfunctionassociatedfattyliverdisease |