Study Objective: Nonalcoholic fatty liver disease (NAFLD) is associated with elevated risk for metabolic syndrome, type 2 diabetes, cardiovascular disease and cirrhosis. Available diagnostic tools (plasma aminotransferases and liver ultrasound) have low sensitivity. This study screened a broad population of children from an endocrine clinic with a combination of imaging tools and biomarkers previously used only in children with known liver disease. We hypothesized that Fibroscan (an ultrasound based imaging tool for hepatic fibrosis) would correlate well with MR-elastography (MRE) and be a useful adjunct in combination with known biomarkers of fatty liver disease to screen for advanced cases of NAFLD.
Methods: Overweight patients were recruited from pediatric and endocrinology clinics. They underwent liver 1H magnetic resonance spectroscopy, magnetic resonance elastography, liver Fibroscan, and fasting lab studies. Plasma biomarkers analyzed included hemoglobin A1c, lipid panel, AST and ALT levels, cytokeratin 18 and homeostatic model of insulin resistance.
Results: Twenty seven patients were recruited and analyzed. NAFLD was present in 30% of patients based on ≥5.5% intrahepatic triglyceride content (liver fat) on 1H-MRS. Five patients (19%) showed fibrosis based on Fibroscan ≥7%, however, only one case was confirmed to have fibrosis on MRE. Two patients with positive Fibroscan were unable to undergo MRE. Metabolic markers including A1c and HOMA-IR were worse in NAFLD vs. no NAFLD patients, but only triglycerides and ALT reached statistical significance.
Conclusions: Fibroscan is useful to eliminate fibrosis, but a positive fibroscan must be further evaluated as many false positives occurred. In combination with triglycerides and ALT, this tool may be useful to stratify those patients most at risk for severe NAFLD and those patients requiring evaluation by pediatric gastroenterologists, biopsy, and more intensive intervention.
K.A. Dayton: None. F. Bril: None. K. Cusi: Consultant; Self; Janssen Global Services, LLC., Eli Lilly and Company. Research Support; Self; Cirius Therapeutics. Other Relationship; Self; Nordic Bioscience. Research Support; Self; Novartis Pharmaceuticals Corporation, Novo Nordisk Inc.. Other Relationship; Self; Quest Diagnostics. Research Support; Self; Zydus Pharmaceuticals (USA) Inc.. Other Relationship; Self; OWL metabolomics, Echosens. Research Support; Self; Janssen Global Services, LLC.. Consultant; Self; Tobira Therapeutics, Pfizer Inc..