A Critical Appraisal of the Definition of Sarcopenia in Patients with Non-Alcoholic Fatty Liver Disease: Pitfall of Adjusted Muscle Mass by Body Weight

Traditionally, sarcopenia has defined as amount of absolute muscle mass adjusted by height in the elderly people. However, relative muscle mass adjusted by weight has been used extensively in most non-alcoholic fatty liver disease (NAFLD) studies. Here, we attempted to investigate the pitfall of adjusted muscle mass by weight to evaluate association between sarcopenia and NAFLD. Adult subjects (n = 1343) who underwent a health check-up were finally included for analysis. The weight-adjusted skeletal muscle mass index (wSMI) and height-adjusted SMI (hSMI) calculated by dividing the total appendicular skeletal muscle (ASM) by weight or the square of height, respectively. Prevalence of sarcopenia defined by wSMI in the NAFLD group was significantly higher than in the control group (1.3% vs. 8.8%, p < 0.001). However, there was no difference in the prevalence of sarcopenia defined by hSMI between the control and NAFLD groups (2.0% vs. 0.8%, p = 0.055). Since body weight was the most potent independent risk factor for NAFLD in multivariable logistic regression analysis, abnormal rates (<−1 SD) of almost all parameters increased in the NAFLD population, after weight adjustment. However, abnormal rates of non-metabolic parameter did not increase in NAFLD, after height adjustment. Only metabolic parameters showed relationship with NAFLD, after height adjustment. As NAFLD is highly associated with body weight, careful attention should be given in the case of studying the relationship of NAFLD with sarcopenia adjusted by body weight

Selecting the Target Population for Screening of Hepatic Fibrosis in Primary Care Centers in Korea

Screening strategies for hepatic fibrosis are heavily focused on patients with fatty liver on sonography in primary care centers. This study aimed to investigate the target population for screening significant hepatic fibrosis in primary care centers. This retrospective cross-sectional cohort study used data from 13 nationwide centers. A total of 5111 subjects who underwent both abdominal sonography and magnetic resonance elastography as part of their health check-up were included. Subjects with viral hepatitis and/or a history of significant alcohol consumption were excluded. Significant and advanced hepatic fibrosis was defined as ≥3.0 kPa and ≥3.6 kPa in the MRE test, respectively. The prevalence of significant and advanced hepatic fibrosis was 7.3% and 1.9%, respectively. Among the subjects with significant hepatic fibrosis, 41.3% did not have fatty liver. Hepatic fibrosis burden increased according to the number of metabolic risk abnormalities. Nearly 70% of subjects with significant hepatic fibrosis also had two or more metabolic risk abnormalities and/or diabetes. However, the prevalence of fibrosis did not differ between the groups with and without fatty liver. The presence of two or more metabolic risk abnormalities was an independent risk factor for significant hepatic fibrosis regardless of the fatty liver. Therefore, in the setting of primary care centers, screening for hepatic fibrosis would better be extended to subjects with metabolically unhealthy status beyond those with fatty liver

Sequential Combination of FIB-4 Followed by M2BPGi Enhanced Diagnostic Performance for Advanced Hepatic Fibrosis in an Average Risk Population

The fibrosis-4 (FIB-4) index is the most widely used estimated formula to screen for advanced hepatic fibrosis; however, it has a considerable intermediate zone. Here, we propose an algorithm to reduce the intermediate zone and improve the diagnostic performance of screening for advanced liver fibrosis by incorporating Mac-2-binding protein glycan isomer (M2BPGi) into a FIB-4 based screening strategy in an average risk group. Four-hundred eighty-eight healthy and chronic liver disease subjects were analyzed using a 1:1 propensity score matched for age and sex. Advanced liver fibrosis (≥F3) was defined by magnetic resonance elastography (MRE, ≥3.6 kPa). Classification tree analysis was employed to improve diagnostic performance using a combination of the FIB-4 index and M2BPGi. The median serum M2BPGi levels of healthy subjects, patients without advanced fibrosis, and those with the condition were 0.48, 0.94, and 2.93, respectively. The area under the receiver operating characteristic (AUROC) curve of M2BPGi (0.918) for advanced fibrosis was the highest compared to those of the FIB-4 index (0.887), APRI (0.873), and AST/ALT ratio (0.794). When M2BPGi was incorporated following the FIB-4 index, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 87.1%, 82.5%, 54.0%, and 96.4%, respectively. Moreover, 74.3% (133/179) of cases in the intermediate zone of the FIB-4 index avoided unnecessary referrals. Two-step pathway (FIB-4 followed by M2BPGi) could reduce unnecessary referrals and/or liver biopsies in an average-risk population

Fibrosis Burden of Missed and Added Populations According to the New Definition of Metabolic Dysfunction-Associated Fatty Liver

Recently, the classification of fatty liver and the definition for non-alcoholic fatty liver disease (NAFLD) have been challenged. Herein, we aim to evaluate the burden of hepatic fibrosis in the missed and added populations following the proposal of the new definition of metabolic dysfunction-associated fatty liver (MAFLD) in a health check-up cohort. A total of 6775 subjects underwent both magnetic resonance elastography (MRE) and an abdominal ultrasound at 13 nationwide health check-up centers in Korea. Significant and advanced hepatic fibrosis was defined as ≥3.0 kPa and ≥3.6 kPa in the MRE test, respectively. The prevalence of sonographic fatty liver (FL) was 47.4%. Among the subjects with sonographic FL, 77.3% and 94% are compatible with NAFLD and with the new MAFLD definitions, respectively. Moreover, 72% of FL cases belong to both the NAFLD and MAFLD definitions, whereas 1.4% is compatible with neither. The population compatible with the MAFLD definition has the following coexisting liver diseases: alcohol-related (71.9%), hepatitis B (23.9%), hepatitis C (0.4%), and both alcohol and viral hepatitis (2.8%). The prevalence of significant and advanced hepatic fibrosis is considerable in the MAFLD-only group. However, the prevalence of significant and advanced hepatic fibrosis is similar in the NAFLD-only group, and neither the NAFLD nor MAFLD group compared to healthy controls. The added population (MAFLD-only group), according to the new MAFLD definition, has a higher metabolic and fibrosis burden when compared to those in the missed population (NAFLD-only group)

Selecting the Target Population for Screening of Hepatic Fibrosis in Primary Care Centers in Korea

Screening strategies for hepatic fibrosis are heavily focused on patients with fatty liver on sonography in primary care centers. This study aimed to investigate the target population for screening significant hepatic fibrosis in primary care centers. This retrospective cross-sectional cohort study used data from 13 nationwide centers. A total of 5111 subjects who underwent both abdominal sonography and magnetic resonance elastography as part of their health check-up were included. Subjects with viral hepatitis and/or a history of significant alcohol consumption were excluded. Significant and advanced hepatic fibrosis was defined as ≥3.0 kPa and ≥3.6 kPa in the MRE test, respectively. The prevalence of significant and advanced hepatic fibrosis was 7.3% and 1.9%, respectively. Among the subjects with significant hepatic fibrosis, 41.3% did not have fatty liver. Hepatic fibrosis burden increased according to the number of metabolic risk abnormalities. Nearly 70% of subjects with significant hepatic fibrosis also had two or more metabolic risk abnormalities and/or diabetes. However, the prevalence of fibrosis did not differ between the groups with and without fatty liver. The presence of two or more metabolic risk abnormalities was an independent risk factor for significant hepatic fibrosis regardless of the fatty liver. Therefore, in the setting of primary care centers, screening for hepatic fibrosis would better be extended to subjects with metabolically unhealthy status beyond those with fatty liver

A survey on the awareness, current management, and barriers for non-alcoholic fatty liver disease among the general Korean population

Abstract Non-alcoholic fatty liver disease (NAFLD) is often diagnosed incidentally during medical evaluation for diseases other than liver disease or during health checkups. This study aimed to investigate the awareness, current status, and barriers to the management of NAFLD in the general population. This cross-sectional study used an online survey, which consisted of 3-domain and 18-item questionnaires. The content validity index for each item of the questionnaire was rated above 0.80. Most respondents (72.8%) reported having heard of the term ‘NAFLD’, and a large proportion of the general population (85.7%) recognized the possibility of developing fatty liver without consuming alcohol. Awareness of the terminology of NAFLD and that NAFLD is a disease that needs to be managed is relatively high. However, the knowledge that NAFLD can progress to end-stage liver disease and new cardiovascular diseases is lacking. Only 25.7% of the general population is aware that NAFLD increases the incidence of heart and cerebrovascular diseases. Only 44.7% of those who were incidentally diagnosed during a health check-up were provided with any specific guidance on NAFLD, and more than half (55.3%) were not provided with education or guidance on NAFLD or did not remember it. Only 40.2% of people diagnosed with NAFLD incidentally visited a clinic. The reason for not visiting a clinic for the evaluation of NAFLD varied greatly depending on sex and age group. Only 40.2% of patients visited the clinic after being diagnosed with NAFLD. The reasons for not visiting the clinic after NAFLD diagnosis differed significantly according to sex and age