scholarly journals Epidemiology, Pathogenesis, and Diagnostic Strategy of Diabetic Liver Disease in Japan

2020 ◽  
Vol 21 (12) ◽  
pp. 4337 ◽  
Author(s):  
Yoshio Sumida ◽  
Toshihide Shima ◽  
Yasuhide Mitsumoto ◽  
Takafumi Katayama ◽  
Atsushi Umemura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Disease ◽  
Hepatic Fibrosis ◽  
Type Iv Collagen ◽  
Diagnostic Strategy ◽  
Advanced Fibrosis ◽  
Non Invasive ◽  
Type Iv ◽  
Nafld Fibrosis Score ◽  
Type Iv Collagen 7S

Type 2 diabetes (T2D) is closely associated with nonalcoholic fatty liver disease (NAFLD). Nonalcoholic steatohepatitis (NASH), a severe form of NAFLD, can lead to cirrhosis, hepatocellular carcinoma (HCC), and hepatic decompensation. Patients with T2D have twice the risk of HCC incidence compared with those without T2D. Because the hepatic fibrosis grade is the main determinant of mortality in patients with NAFLD, identifying patients with advanced fibrosis using non-invasive tests (NITs) or imaging modalities is crucial. Globally, the fibrosis-4 index (FIB-4 index), NAFLD fibrosis score, and enhanced liver fibrosis test have been established to evaluate hepatic fibrosis. Two-step algorithms using FIB-4 index as first triaging tool are globally accepted. It remains unknown which kinds of NITs or elastography are best as the second step tool. In Japan, type IV collagen 7s or the CA-fibrosis index (comprising type IV collagen 7s and aspartate aminotransferase (AST)) is believed to precisely predict advanced fibrosis in NAFLD. Patients with NAFLD who have high non-invasive test results should be screened for HCC or esophageal varices. Risk factors of rapid fibrosis progression in NAFLD includes age, severe obesity, presence of T2D, menopause in women, and a patatin-like phospholipase domain containing the 3 GG genotype. Patients with NAFLD who have these risk factors should be intensively treated with lifestyle modification or pharmacotherapies for preventing liver-related mortality.

scholarly journals Type IV Collagen 7S Is the Most Accurate Test For Identifying Advanced Fibrosis in NAFLD With Type 2 Diabetes

2020 ◽  
Author(s):  
Hiroshi Ishiba ◽  
Yoshio Sumida ◽  
Yuya Seko ◽  
Saiyu Tanaka ◽  
Masato Yoneda ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type Iv Collagen ◽  
Advanced Fibrosis ◽  
Type Iv ◽  
Type Iv Collagen 7S

scholarly journals Advancement of hepatic fibrosis among general women with/without NAFLD

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
R Ibusuki ◽  
I Shimoshikiryo ◽  
K Shimatani ◽  
D Nishimoto ◽  
S Maenohara ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
General Population ◽  
Fatty Liver ◽  
Hepatic Fibrosis ◽  
Type Iv Collagen ◽  
Related Factors ◽  
Abdominal Ultrasonography ◽  
Type Iv ◽  
Type Iv Collagen 7S

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is increasing, being prevalent at 30% of the general population worldwide. A part of NAFLD develops nonalcoholic steatohepatitis (NASH), liver cirrhosis and hepatocellular carcinoma. Hepatic fibrosis plays an important role in their pathogenesis. However, it is unclear how hepatic fibrosis is observed and advanced in NAFLD among general population. To investigate the hepatic fibrosis among general population, we prospectively observed hepatic fibrosis using serum markers. Methods The subjects were 228 women who participated as a part of the Japan Multi-Institutional Collaborative Cohort (J-MICC) study in Kagoshima, Japan, and were followed from 2005 to 2014. NAFLD was defined as fatty liver by abdominal ultrasonography; consuming ethanol < 20 g/day; and being none hepatitis B and C carriers. NAFLD were confirmed after two-time consecutive examination, because its disappearance is ambiguous in some cases. Hepatic fibrosis was evaluated using serum M2BPGi and Type IV collagen 7s. The comparison of their changed values between groups was done using the ANOVA adjusted for age. The association between their change and related factors was done using general linear regression model. Results The prevalence of NAFLD was 31.6% at baseline. In the 5-year observation, the NAFLD + => NAFLD + ( ++) group was 23.7%; − +, 2.6%; + −, 7.9%; and - - (control), 65.8%. The values of M2BPGi and Type IV collagen 7s were higher in ++, -+, +- groups than controls at baseline. The change of M2BPGi values was observed in all groups, including controls, and the changed values were higher in ++ and -+ groups. Higher creatinine levels were positively associated with change of M2BPGi values. In contrast, the change of Type IV collagen 7s was not apparent. Conclusions This study suggested hepatic fibrosis was advanced with age among general women without NAFLD, and the presence of NAFLD enhanced hepatic fibrosis more. Key messages Hepatic fibrosis may be slightly developing with age among general population, and will be enhanced with fatty liver. It is important to prevent fatty liver development to control risk factors, such as obesity and metabolic syndrome, to reduce the risk of NASH, liver cirrhosis and hepatocellular carcinoma.

scholarly journals The Validation of Conventional Non-Invasive Fibrosis Scoring Systems in Patients with Metabolic Associated Fatty Liver Disease

2020 ◽  
Author(s):  
Yinlian Wu ◽  
Rahul Kumar ◽  
Mingfang Wang ◽  
Medha Singh ◽  
Jiaofeng Huang ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Characteristic Curve ◽  
Scoring Systems ◽  
Advanced Fibrosis ◽  
Discrimination Ability ◽  
Non Invasive ◽  
Nafld Fibrosis Score ◽  
The Difference

Abstract Background：Non-invasive fibrosis scores are not yet validated in the newly defined metabolic associated fatty liver disease (MAFLD). This study evaluated the diagnostic performance of four non-invasive scores including AST to platelet ratio index (APRI), fibrosis-4 index (FIB-4), BMI, AST/ALT ratio, and diabetes score (BARD), and NAFLD fibrosis score(NFS) in patients with MAFLD.Methods: Consecutive patients with histologically-confirmed MAFLD were included. The discrimination ability of different non-invasive scores was compared.Results: A total of 417 patients were included, 156 (37.4%) of them had advanced fibrosis (METAVIR ≥F3). The area under receiver operating characteristic curve (AUROC) of FIB-4, NFS, APRI and BARD for predicting advanced fibrosis were 0.736, 0.724, 0.671 and 0.609 respectively. The AUROC between FIB-4 and NFS were similar (P=0.523), while the difference between FIB-4 and APRI (P=0.001) and FIB-4 and BARD (P<0.001) was statistically significant. The best thresholds of FIB-4，NFS，APRI and BARD for diagnosis of advanced fibrosis in MAFLD were 1.05, -2.1, 0.42 and 2. A subgroup analysis showed that FIB-4, APRI and NFS performed worse in pure MAFLD than HBV-MAFLD group.Conclusions: APRI and BARD score do not perform well in MAFLD. The FIB-4 and NFS could be more useful but new threshold is needed. Novel non-invasive scoring system for fibrosis is required for MAFLD.

Diagnosis of Non-alcoholic Fatty Liver Disease (NAFLD): Current Concepts

2019 ◽  
Vol 24 (38) ◽  
pp. 4574-4586 ◽  
Author(s):  
Margarita Papatheodoridi ◽  
Evangelos Cholongitas
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Diagnostic Tools ◽  
Routine Practice ◽  
Advanced Fibrosis ◽  
Disease Etiology ◽  
Alcoholic Fatty Liver ◽  
Non Invasive ◽  
Nafld Fibrosis Score

Nonalcoholic fatty liver disease (NAFLD) ranges from simple hepatic steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. The majority of NAFLD patients do not progress to NASH and their morbidity risk is low. However, clinical and economic burden of the disease is considerable since the prevalence of the disease is estimated as high as 25% of the general population. Liver biopsy remains the current gold standard for diagnosis, despite limitations regarding sampling variability, invasive nature, and high cost. However, numerous non-invasive biomarkers, including mainly serum markers or imaging modalities, intend to detect the presence of steatosis, NASH or advanced fibrosis. To date, ultrasound is suggested as first-line screening tool for defining steatosis in a selected population, while diagnosis of NAFLD requires exclusion of other chronic liver disease etiology or other steatosis causes. A crucial step in the management of NAFLD patients is the identification of advanced fibrosis, which may be reliably excluded by using NAFLD-Fibrosis score or FIB-4 score or by performing transient elastography. The most robust modalities implement Magnetic Resonance technology and manage to accurately quantify steatosis or identify fibrosis stage, but are not yet applicable in routine practice. The most challenging endpoint has proved to be a non-invasive diagnosis of NASH since no reliable biomarkers have been found to detect or predict inflammation in NAFLD. Lately, research focuses on validating existing markers as robust diagnostic tools for clinical use and investigating novel experimental markers of disease. Current strategies concepts aim to safely diagnose NAFLD patients, aid drug development and finally, guide personalised treatment.

scholarly journals Serum metabolites detect the presence of advanced fibrosis in derivation and validation cohorts of patients with non-alcoholic fatty liver disease

Gut ◽  
2018 ◽  
Vol 68 (10) ◽  
pp. 1884-1892 ◽  
Author(s):  
Cyrielle Caussy ◽  
Veeral H Ajmera ◽  
Puneet Puri ◽  
Cynthia Li-Shin Hsu ◽  
Shirin Bassirian ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Unmet Need ◽  
Advanced Fibrosis ◽  
Alcoholic Fatty Liver ◽  
Serum Metabolites ◽  
Non Invasive ◽  
Nafld Fibrosis Score ◽  
Alcoholic Fatty Liver Disease

ObjectiveNon-invasive and accurate diagnostic tests for the screening of disease severity in non-alcoholic fatty liver disease (NAFLD) remain a major unmet need. Therefore, we aimed to examine if a combination of serum metabolites can accurately predict the presence of advanced fibrosis.DesignThis is a cross-sectional analysis of a prospective derivation cohort including 156 well-characterised patients with biopsy-proven NAFLD and two validation cohorts, including (1) 142 patients assessed using MRI elastography (MRE) and(2) 59 patients with biopsy-proven NAFLD with untargeted serum metabolome profiling.ResultsIn the derivation cohort, 23 participants (15%) had advanced fibrosis and 32 of 652 analysed metabolites were significantly associated with advanced fibrosis after false-discovery rate adjustment. Among the top 10 metabolites, 8 lipids (5alpha-androstan-3beta monosulfate, pregnanediol-3-glucuronide, androsterone sulfate, epiandrosterone sulfate, palmitoleate, dehydroisoandrosterone sulfate, 5alpha-androstan-3beta disulfate, glycocholate), one amino acid (taurine) and one carbohydrate (fucose) were identified. The combined area under the receiver operating characteristic curve (AUROC) of the top 10 metabolite panel was higher than FIB--4 and NAFLD Fibrosis Score (NFS) for the detection of advanced fibrosis: 0.94 (95% CI 0.897 to 0.982) versus 0.78 (95% CI0.674 to 0.891), p=0.002 and versus 0.84 (95% CI 0.724 to 0.929), p=0.017, respectively. The AUROC of the top 10 metabolite panel remained excellent in the independent validation cohorts assessed by MRE or liver biopsy: c-statistic of 0.94 and 0.84, respectively.ConclusionA combination of 10 serum metabolites demonstrated excellent discriminatory ability for the detection of advanced fibrosis in an derivation and two independent validation cohorts with greater diagnostic accuracy than the FIB-4-index and NFS. This proof-of-concept study demonstrates that a non-invasive blood-based diagnostic test can provide excellent performance characteristics for the detection of advanced fibrosis.

scholarly journals Step layered combination of noninvasive fibrosis models improves diagnostic accuracy of advanced fibrosis in nonalcoholic fatty liver disease

2019 ◽  
Vol 28 (3) ◽  
pp. 289-296 ◽  
Author(s):  
Mei Yang ◽  
Lina Jiang ◽  
Yijin Wang ◽  
Xi Li ◽  
Zhengsheng Zou ◽  
...  
Keyword(s):  
Liver Disease ◽  
Diagnostic Accuracy ◽  
Fatty Liver ◽  
Predictive Value ◽  
Fatty Liver Disease ◽  
Validation Cohort ◽  
Advanced Fibrosis ◽  
Alcoholic Fatty Liver ◽  
Non Invasive ◽  
Nafld Fibrosis Score

Background and Aims: Liver fibrosis is stage-dependently associated with non-alcoholic fatty liver disease (NAFLD) progression. The increased awareness of non-invasive diagnosis has led to the establishment of many fibrosis diagnosis models with various accuracies. We aimed to evaluate the diagnostic performance of nine clinical non-invasive fibrosis models in NAFLD and provide an optimal diagnostic method for advanced fibrosis by step layered combination of non-invasive models. Methods: 453 consecutive patients with biopsy-proven NAFLD were enrolled from three centers and were divided into study cohort and validation cohort randomly. Aspartate aminotransferase-to-platelet ratio index (APRI), BARD, FiB-4, FibroMeter NAFLD, Forns’ Index, Hui model, non-invasive Koeln-Essen- index (NIKEI), S Index and NAFLD fibrosis score (NFS) were calculated. The high area under the receiver operating characteristic curve (AUROC) models were stepwise combined for further diagnosing NAFLD advanced fibrosis. Results: All models had good performance with high negative predictive value (NPV) and specificity for diagnosing fibrosis, while positive predictive value (PPV) and sensitivity were low. APRI, BARD, FibroMeter NAFLD and NIKEI had higher AUROCs and their step layered combination for diagnosing advanced fibrosis showed high specificity, sensitivity, NPV and PPV up to 89.13%, 72.50%, 74.36%, and 88.17%, which also performed well in the validation cohort. Conclusions: APRI, BARD, FibroMeter NAFLD and NIKEI had better diagnostic accuracy, and could be preferred for diagnosing NAFLD fibrosis. The step layered combination of these models performed much better than each single scoring system for diagnosing advanced fibrosis, provides valuable reference for clinical practice and might be a potential substitution of liver biopsy.

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