X.L.ANG1, M.C.MOH1, K.C.P.SZE1, X.H.TEOH1, C.F.SUM2, S.TAVINTHARAN2, S.C.LIM1
Khoo Teck Puat Hospital1, Admiralty Medical Centre2
Transient elastography (Fibroscan) is a non-invasive alternative to liver biopsy, with satisfactory accuracy and reproducibility for estimating liver fibrosis by measurement of liver stiffness. Limited by the high cost and availability of Fibroscan in community care settings, we evaluated whether non-invasive liver fibrosis indices may serve as proxies for liver stiffness measurement across body mass index (BMI) categories.
The pilot cross-sectional study involved subjects with type 2 diabetes (age:53±13 years, 58.1% male) subgrouped by Asian BMI: BMI<23 (normal, n=16), BMI≥23−26.9 (overweight, n=24), and BMI≥27 (obese, n=46) kg/m2. Fibroscan M and XL probes were used to capture liver stiffness measurements (LSM). Liver fibrosis indices including Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS), Aspartate aminotransferase to Platelet Ratio Index (APRI), and Fibrosis-4 (FIB-4) were calculated based on clinical parameters.
In the normal BMI group, Pearson’s correlation revealed significant correlation between M probe-LSM and NFS (r=0.731, P<0.001), APRI (r=0.663, P<0.005), or FIB-4 (r=0.807, P<0.001). XL probe LSM was also correlated with NFS (r=0.726, P<0.001), APRI (r=0.639, P<0.008), or FIB-4 (r=0.758, P<0.001). In the overweight/obese group, correlation between LSM and the fibrosis indices was almost non-existent, except between APRI and M probe LSM (r=0.465, P<0.004) or XL probe LSM (r=0.424, P<0.004) in the obese group.
NFS, APRI and FIB-4 are useful in estimating liver stiffness in people with normal BMI. However, their utility in estimating liver stiffness among overweight/obese individuals is limited. Further investigations are required for sourcing alternatives to predict liver stiffness in higher BMI individuals