TY - JOUR
T1 - Noninvasive tests for nonalcoholic fatty liver disease in a multi-ethnic population
T2 - The HELIUS study
AU - van Dijk, Anne-Marieke
AU - Vali, Yasaman
AU - Mak, Anne Linde
AU - Galenkamp, Henrike
AU - Nieuwdorp, Max
AU - van den Born, Bert-Jan
AU - Holleboom, Adriaan Georgius
N1 - Funding Information: The HELIUS study is conducted by the Amsterdam University Medical Centers (location AMC) and the Public Health Service of Amsterdam. Both organizations provided core support for HELIUS. The HELIUS study is also funded by the Dutch Heart Foundation (2010 T084), the Netherlands Organization for Health Research and Development (200500003), the European Union (FP‐7; 278901), and the European Fund for the Integration of non‐EU immigrants (2013EIF013). We are most grateful to the participants of the HELIUS study and the management team, research nurses, interviewers, research assistants, and other staff who have taken part in gathering the data of this study. The study reported here was additionally supported by an additional grant from Novo Nordisk. MN is supported by a ZONMW VICI grant 2020 (09150182010020). AGH is supported by the Amsterdam UMC Fellowship, TKI‐PPP Health~Holland grants, and grants from the Dutch Gastroenterology Foundation. Publisher Copyright: © 2022 The Authors. Hepatology Communications published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.
PY - 2022
Y1 - 2022
N2 - Nonalcoholic fatty liver disease (NAFLD) is increasing in prevalence and severity globally, prompting noninvasive testing, yet limited data exist on noninvasive liver tests (NITs) including transient elastography (TE) in ethnically diverse populations. Therefore, we studied prevalence and ethnic differences in NAFLD with NITs in the multi-ethnic HEalthy Life In an Urban Setting (HELIUS) cohort. NITs of liver steatosis (Fatty Liver Index [FLI]) and fibrosis (Fibrosis-4 index [FIB-4], and aspartate aminotransferase–to–platelet ratio [APRI]) were assessed in 10,007 participants. A subpopulation of 399 participants, selected on high-risk criteria for NAFLD (obesity, type 2 diabetes mellitus [T2DM], and/or elevated NITs), was examined with TE. FLI was ≥60 in 27.3% of 10,007 participants, indicating steatosis. Most participants (71.8%) had FIB-4 < 1.30, excluding advanced liver fibrosis, and 1.1% (n = 113) had high FIB-4 (FIB-4 ≥ 2.67), indicating likely advanced liver fibrosis. In the TE subpopulation, 37.8% and 17.3% had steatosis and fibrosis (continuation attenuation parameter [CAP] ≥ 280 dB/m, liver stiffness measurement [LSM] ≥ 7.0 kPa, respectively). Turkish participants had highest adjusted odds ratio (OR) for elevated LSM (1.72, 95% confidence interval [CI] 0.59–5.01) and Ghanaians the lowest (0.24, 95% CI 0.09–0.65). Ghanaians had lowest adjusted OR for elevated CAP: 0.18 (95% CI 0.09–0.37). In diabetics, CAP and LSM were 17.6% and 14.6% higher than in nondiabetics, respectively. Correlations of FIB-4 and APRI with LSM were absent and weak. Conclusion: Liver steatosis proxy FLI was elevated in 27.3% of this multi-ethnic population. In Turkish background and in those with T2DM, proxies for steatosis and fibrosis were high, whereas in Ghanaian background, NITs were generally low. Together, this warrants awareness for NAFLD among high-risk populations, taking ethnic background into account. The absence of clear correlation between FIB-4 and APRI with LSM questions the accuracy of these fibrosis NITs to detect advanced fibrosis in the general population.
AB - Nonalcoholic fatty liver disease (NAFLD) is increasing in prevalence and severity globally, prompting noninvasive testing, yet limited data exist on noninvasive liver tests (NITs) including transient elastography (TE) in ethnically diverse populations. Therefore, we studied prevalence and ethnic differences in NAFLD with NITs in the multi-ethnic HEalthy Life In an Urban Setting (HELIUS) cohort. NITs of liver steatosis (Fatty Liver Index [FLI]) and fibrosis (Fibrosis-4 index [FIB-4], and aspartate aminotransferase–to–platelet ratio [APRI]) were assessed in 10,007 participants. A subpopulation of 399 participants, selected on high-risk criteria for NAFLD (obesity, type 2 diabetes mellitus [T2DM], and/or elevated NITs), was examined with TE. FLI was ≥60 in 27.3% of 10,007 participants, indicating steatosis. Most participants (71.8%) had FIB-4 < 1.30, excluding advanced liver fibrosis, and 1.1% (n = 113) had high FIB-4 (FIB-4 ≥ 2.67), indicating likely advanced liver fibrosis. In the TE subpopulation, 37.8% and 17.3% had steatosis and fibrosis (continuation attenuation parameter [CAP] ≥ 280 dB/m, liver stiffness measurement [LSM] ≥ 7.0 kPa, respectively). Turkish participants had highest adjusted odds ratio (OR) for elevated LSM (1.72, 95% confidence interval [CI] 0.59–5.01) and Ghanaians the lowest (0.24, 95% CI 0.09–0.65). Ghanaians had lowest adjusted OR for elevated CAP: 0.18 (95% CI 0.09–0.37). In diabetics, CAP and LSM were 17.6% and 14.6% higher than in nondiabetics, respectively. Correlations of FIB-4 and APRI with LSM were absent and weak. Conclusion: Liver steatosis proxy FLI was elevated in 27.3% of this multi-ethnic population. In Turkish background and in those with T2DM, proxies for steatosis and fibrosis were high, whereas in Ghanaian background, NITs were generally low. Together, this warrants awareness for NAFLD among high-risk populations, taking ethnic background into account. The absence of clear correlation between FIB-4 and APRI with LSM questions the accuracy of these fibrosis NITs to detect advanced fibrosis in the general population.
UR - http://www.scopus.com/inward/record.url?scp=85141523701&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/hep4.2109
DO - https://doi.org/10.1002/hep4.2109
M3 - Article
C2 - 36333949
SN - 2471-254X
JO - Hepatology communications
JF - Hepatology communications
ER -