Use of liver steatosis and fibrosis indices in overweight and obese patients with or without carbohydrate metabolism disorders

BACKGROUND: Currently, much attention is paid to the search for highly informative and non-invasive methods for screening the progression of non-alcoholic fatty liver disease (NAFLD) through the stages of «steatohepatosis-steatohepatitis-fibrosis». Such non-invasive methods include tests based on serum markers and/or biometric indicators. The differences in cut-off diagnostic thresholds for some fibrosis indices and the use of a point scale, which includes the presence/absence of diabetes or other carbohydrate metabolism disorders (CMDs) in calculating other indices (NAFLD-LFS, BARD, NFS) make the issue of the applicability of these indices in a cohort of patients with prediabetes and T2DM relevant.

AIM: To study clinical and laboratory associations of liver steatosis and fibrosis indices in overweight and obese patients depending on CMD, and to evaluate the diagnostic significance of individual steatosis and fibrosis indices in this cohort of patients.

MATERIALS AND METHODS: All patients underwent a comprehensive clinical and laboratory examination, liver fibrosis screening by ultrasound liver fibroelastometry, and liver MRI in IDEAL-IQ mode. The steatosis index FLI and fibrosis indices FIB-4, APRI, BARD, and NFS were calculated. Statistical processing of the results included comparative analysis, frequency analysis, correlation — and ROC analysis.

RESULTS: The study included 114 patients with overweight or obesity divided into groups depending on the CMD: group 1 — without CMD (n=52), group 2 — prediabetes (n=34), group 3 — newly diagnosed T2DM (n=28). We verified significant differences depending on CMD only for the NFS index: in individuals with T2DM, the NFS index was significantly higher than in individuals with impaired glucose tolerance (IGT) and significantly higher than in the group without CMD. In IGT patients, the NFS values significantly exceeded those in the group without CMD. According to the APRI and FIB4 assessment, no cases of advanced (≥F2) fibrosis were found in the obtained sample. The APRI index demonstrated sufficient informative value regarding F2 fibrosis (area under the curve=0.687; p=0.008) in the cohort of obese and overweight patients without taking into account the CMD.

CONCLUSION: Non-invasive tests have potential for detecting liver fibrosis, but require further study regarding applicability to a cohort of patients with CMD.

1. Maevskaya MV, Kotovskaya YV, Ivashkin VT, et al. The National Consensus statement on the management of adult patients with non-alcoholic fatty liver disease and main comorbidities. Terapevticheskii Arkhiv. 2022;94(2):216–253. (In Russ). doi: https://doi.org/10.26442/00403660.2022.02.201363

2. Ajmera V, Cepin S, Tesfai K, et al. A prospective study on the prevalence of NAFLD, advanced fibrosis, cirrhosis and hepatocellular carcinoma in people with type 2 diabetes. J Hepatol. 2023;78(3):471- 478. doi: https://doi.org/10.1016/j.jhep.2022.11.010

3. Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835. doi: https://doi.org/10.1097/HEP.0000000000000323

4. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of nonalcoholic fatty liver disease. J Hepatol. 2016;64(6):1388-1402. doi: https://doi.org/10.1016/j.jhep.2015.11.004

5. Szczepaniak LS, Nurenberg P, Leonard D, et al. Magnetic resonance spectroscopy to measure hepatic triglyceride content: prevalence of hepatic steatosis in the general population. Am J Physiol Endocrinol Metab. 2005;288(2):E462-E468. doi: https://doi.org/10.1152/ajpendo.00064.2004

6. Cuthbertson DJ, Koskinen J, Brown E, et al. Fatty liver index predicts incident risk of prediabetes, type 2 diabetes and non-alcoholic fatty liver disease (NAFLD). Ann Med. 2021;53(1):1256-1264. doi: https://doi.org/10.1080/07853890.2021.1956685

7. Kaneva AM, Bojko ER. Fatty liver index (FLI): more than a marker of hepatic steatosis. J Physiol Biochem. 2024;80(1):11-26. doi: https://doi.org/10.1007/s13105-023-00991-z

8. Busquets-Cortés C, Bennasar-Veny M, López-González AA, et al. Fatty liver index and progression to type 2 diabetes: a 5-year longitudinal study in Spanish workers with pre-diabetes. BMJ Open. 2021;11(8):e045498. doi: https://doi.org/10.1136/bmjopen-2020-045498

9. Bakulin IG, Vinnytskaya EV, Sandler YG, et al. Assessment of liver fibrosis in patients with diabetes mellitus. Farmateka. 2016;2:43–48. (In Russ.)

10. Bakulin IG, Sandler YG, Vinnytskaya EV, et al. Diabetes Mellitus and New Point of View: from Hepatic Steatosis to Fibrosis. Doctor.Ru. 2016;10(127):16-22. (In Russ.)

11. Stolbova SK, Dragomiretskaya NA, Beliaev IG, Podzolkov VI. Clinical and laboratory associations of liver fibrosis indexes in patients with decompensated Chronic Heart Failure II-IV Functional Classes. Kardiologiia. 2020;60(5):90–99. (In Russ). doi: https://doi.org/10.18087/cardio.2020.5.n920

12. Bertot LC, Jeffrey GP, de Boer B, et al. Diabetes impacts prediction of cirrhosis and prognosis by non-invasive fibrosis models in non-alcoholic fatty liver disease. Liver Int. 2018;38(10):1793-1802. doi: https://doi.org/10.1111/liv.13739

13. Singh A, Gosai F, Siddiqui MT, et al. Accuracy of noninvasive fibrosis scores to detect advanced fibrosis in patients with type-2 diabetes with biopsy-proven nonalcoholic fatty liver disease. J Clin Gastroenterol. 2020;54(10):891-897. doi: https://doi.org/10.1097/MCG.0000000000001339

14. Singh A, Garg R, Lopez R, Alkhouri N. Diabetes liver fibrosis score to detect advanced fibrosis in diabetics with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2022;20(3):e624-e626. doi: https://doi.org/10.1016/j.cgh.2021.01.010