Relationship between drinking frequency and fatty liver prevalence or incidence in Japanese undergoing health checkup in 2008-2019

Evaluating the relative importance of different blood pressure indices in screening for NAFLD: a survey report based on a health examination population

Objective

While hypertension is a well-recognized risk factor for non-alcoholic fatty liver disease (NAFLD), the specific roles of various common blood pressure measurements [diastolic blood pressure (DBP), systolic blood pressure (SBP), pulse pressure (PP), mean arterial pressure (MAP)] in detecting NAFLD and evaluating the associated risk in adults remain unclear.

Methods

A retrospective analysis was conducted on 14,251 adult participants undergoing health screenings in the NAfld in the Gifu Area, Longitudinal Analysis project (NAGALA). Following the Z-transformation of the independent variables, we evaluated the relationships between the four blood pressure indices and NAFLD through multivariable logistic regression models. This analysis documented the odds ratio (OR) and 95% confidence interval (CI) for each standard deviation (SD) increase. Additionally, the effectiveness of these indices in identifying NAFLD was comparatively analyzed using receiver operating characteristic (ROC) curves.

Results

After adequately adjusting for confounders, all blood pressure indices except PP showed a positive correlation with NAFLD. For each SD increment, MAP had the strongest association with NAFLD compared to SBP and DBP. This finding was confirmed in populations without exercise habits, under 60 years of age, with normal blood pressure, and in non-obese groups. Furthermore, based on ROC analysis, MAP was found to have the highest accuracy in identifying NAFLD compared to the other three blood pressure indices.

Conclusion

Among the four blood pressure indices evaluated, MAP demonstrates the greatest efficacy in identifying NAFLD and assessing its associated risk. These findings underscore the potential of MAP as the most promising blood pressure index for screening NAFLD.

Usefulness of health checkup for screening metabolic dysfunction-associated fatty liver disease and alcohol-related liver disease in Japanese male young adults

We aimed to assess metabolic dysfunction-associated fatty liver disease (MAFLD) and alcohol-related liver disease (ALD) prevalence in young male adults and the role of health checkups in disease screening. We recruited 313 male graduate students at Gifu University in April 2022. With hepatic steatosis diagnosed by ultrasonography, MAFLD and nonalcoholic fatty liver disease (NAFLD) were diagnosed based on health checkup data, and ALD was diagnosed with alcohol consumption > 30 g/day. The ability of each variable to identify MAFLD, NAFLD, and ALD was assessed using logistic regression and receiver-operating characteristic curve analyses. Participants' mean age was 23 (± 4) years, and MAFLD, NAFLD, and ALD prevalence was 11%, 17%, and 1%, respectively. Among Japanese male young adults, alanine aminotransferase (ALT) (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.01-1.07; P = 0.008) and body mass index (BMI) (OR 2.02; 95% CI 1.58-2.58; P < 0.001) were independently associated with MAFLD. Furthermore, only the alcohol use disorders identification test (AUDIT) was able to identify ALD (OR 1.49; 95% CI, 1.28-1.74; P = 0.001). Our study revealed that health checkups, including measurement of ALT, BMI, and AUDIT, are important for screening MAFLD and ALD in younger generations.

Prevalence of fatty liver and advanced fibrosis by ultrasonography and FibroScan in a general population random sample

AIM

Fatty liver is the most common liver disease. This study examined fatty liver and advanced fibrosis prevalence in a random sample of the Japanese general population.

METHODS

A total of 6000 people randomly selected from two cities in Hiroshima Prefecture were invited to participate in this cross-sectional study originally carried out for hepatitis virus screening. Ultrasonography and FibroScan (controlled attenuation parameter [CAP] and liver stiffness measurement [LSM]) were provided as additional tests.

RESULTS

Of 6000 invited individuals, 1043 participated in hepatitis virus screening, of which 488 randomly selected individuals (median age, 56 years; interquartile range, 45-68 years; male participants, 49.8%) underwent ultrasonography, CAP, and LSM. Ultrasonography showed fatty liver in 24.6% and mild fatty liver in 32.8%. Controlled attenuation parameter showed severe steatosis in 27.5%, moderate steatosis in 12.5%, and mild steatosis in 11.1%. Overall, 62.1% were diagnosed with fatty liver based on ultrasonography or CAP. Nonalcoholic fatty liver disease (NAFLD) prevalence was 50.6%. Liver stiffness measurement found cirrhosis in 1.0% and severe fibrosis in 1.8%. Multivariate analysis of risk factors associated with ≥F2 or higher liver fibrosis showed that age ≥60 years and above (adjusted odds ratio [AOR], 3.2; 95% confidence interval [CI], 1.5-6.9; p = 0.0031), hepatitis C virus antibody positivity (AOR, 8.4; 95% CI, 1.0-68.4; p = 0.0467), and fatty liver (AOR, 2.3; 95% CI, 1.1-6.2; p = 0.0317) are independent risk factors.

CONCLUSIONS

In the general population, 62.1% had fatty liver, and NAFLD prevalence was twice as high as previously reported. Screening that is noninvasive, low-cost, and does not require special techniques or equipment is needed to detect advanced liver fibrosis.

Distribution of FIB-4 index in the general population: analysis of 75,666 residents who underwent health checkups

Background

Fatty liver is frequently found in a general population, and it is critical to detect advanced fibrosis. FIB-4 index is considered a useful marker for evaluating liver fibrosis but the distribution of FIB-4 index in the general population remains unknown.

Methods

This cross-sectional study included residents who underwent ultrasonography at health checkups in Hiroshima or Iwate prefectures. The distribution of FIB-4 index in the total study population (N = 75,666) as well as in non-alcoholic fatty liver disease (NAFLD) populations (N = 17,968) and non-drinkers without fatty liver populations (N = 47,222) was evaluated. The distribution of aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT) levels was also evaluated.

Results

The mean FIB-4 index in the total study population was 1.20 ± 0.63. FIB-4 index ≥ 2.67, which indicates a high risk of liver fibrosis, was found in 16.4% of those aged ≥ 70 years. In the NAFLD population, 58.1% of those in their 60 s and 88.1% of those ≥ 70 years met the criteria for referral to hepatologists by using the recommended FIB-4 index cutoff value (≥ 1.3). The mean FIB-4 index in the NAFLD population (1.12 ± 0.58) was significantly lower than in the non-drinkers without fatty liver (1.23 ± 0.63, p < 0.0001). The non-drinkers without fatty liver tended to have higher AST relative to ALT levels (60.0% with AST/ALT > 1.0), whereas the results in the NAFLD population were opposite (14.8% with AST/ALT > 1.0). AST > ALT resulted in a higher FIB-4 index in non-drinkers without fatty liver due to the nature of FIB-4 index formula.

Conclusions

The cutoff value of FIB-4 index (≥ 1.3) for triaging the elderly people with fatty liver for referral to hepatologists should be reconsidered to avoid over-referral. Due to the impact of age and characteristics of AST/ALT ratios, there is no prospect of using FIB-4 index for primary screening for liver fibrosis in a general population of unknown presence or absence of liver disease, even though it can be easily calculated using routine clinical indices. It is desired to develop a non-invasive method for picking up cases with advanced fibrosis latent in the general population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-022-02290-1.