eISSN: 2449-8238
ISSN: 2392-1099
Clinical and Experimental Hepatology
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2/2021
vol. 7
 
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abstract:
Original paper

Comparative analysis of metabolic risk factors for progression of non-alcoholic fatty liver disease

Vincent J. H. Yao
1
,
Michael Sun
2
,
Aivi A. Rahman
1
,
Zachariah Samuel
1
,
Joyce Chan
3
,
Elizabeth Zheng
4
,
Alan C. Yao
5

  1. CUNY School of Medicine/Sophie Davis Biomedical Education Program, New York, USA
  2. Cornell University, College of Agriculture and Life Sciences, Ithaca, USA
  3. The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, The People’s Republic of China
  4. Columbia University Medical Center, New York, USA
  5. Long Island Jewish Medical Center, Northwell Health, New York, USA
Clin Exp HEPATOL 2021; 7, 2: 241-247
DOI: https://doi.org/10.5114/ceh.2021.107567
Online publish date: 2021/07/13
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Introduction
Non-alcoholic fatty liver disease (NAFLD), a globally prevailing chronic liver condition, refers to a spectrum of disease ranging from bland steatosis to steatohepatitis causing fibrosis without significant alcohol intake. Prominent risk factors (RFs) include obesity, type 2 diabetes mellitus, and dyslipidemia. Currently, no established hierarchy exists for the influence of metabolic RFs on NAFLD progression. This retrospective cohort study investigated and ranked the independent and combined effects of three major RFs on NAFLD progression.

Material and methods
652 NAFLD patients with ≥ 1 RF were categorized by RF combination to examine yearly changes in RF severity with liver stiffness measurement (LSM) over five years. Body mass index (BMI), hemoglo- bin A1c (HbA1c), total cholesterol (TC), and LSM were reviewed.

Results
In patients with any single improving RF, decreases in BMI were associated with a yearly LSM change of –1.26 kPa, while decreases in HbA1c and TC were associated with a change of –0.51 kPa and –0.56 kPa, respectively. In patients with any single worsening RF, increases in BMI were correlated with an LSM change of +0.74 kPa and increases in HbA1c and TC were correlated with a change of +0.43 kPa and +0.16 kPa, respectively. Patients with three RFs had the greatest LSM changes for both improving (–3.68 kPa) and worsening (+3.19 kPa) groups. The strongest predictors for LSM change were BMI and HbA1c, with standardized b coefficients of 0.236 and 0.226 (p < 0.001), while TC had the least influence [0.112 (p < 0.01), F(3,647) = 11.458, p < 0.001, R² = 0.155].

Conclusions
Obesity was the most prominent RF. Treatment of all three RFs over a five-year period presented a high likelihood of fibrosis stage regression for NAFLD patients.

keywords:

fibrosis, NAFLD, risk factor, transient elastography, liver stiffness measurement
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