Kenichi Tanaka1,2, Hirokazu Takahashi1,2, Hideyuki Hyogo3, Masafumi Ono4, Noriko Oza1,5, Yoichiro Kitajima1,2, Miwa Kawanaka6, Kazuaki Chayama7, Toshiji Saibara4, Keizo Anzai1, Yuichiro Eguchi8. 1. Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga, Japan. 2. Clinical Gastroenterology, Eguchi Hospital, Saga, Japan. 3. Department of Gastroenterology and Hepatology, JA Hiroshima General Hospital, Hiroshima, Japan. 4. Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan. 5. Department of Hepatobiliary and Pancreatology, Saga-Ken Medical Centre Koseikan, Saga, Japan. 6. Department of General Internal Medicine 2, General Medical Center, Kawasaki Medical School, Okayama, Japan. 7. Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. 8. Liver Center, Saga University Hospital, Saga, Japan.
Abstract
AIM: The association between glycemia and liver fibrosis was analyzed using hemoglobin A1c (HbA1c) and the Fibrosis-4 (FIB-4) index in a large general population cohort that underwent a health checkup. METHODS: A total of 6927 subjects without hepatitis B or C virus infection or habitual alcohol intake were enrolled. Non-alcoholic fatty liver disease (NAFLD) was diagnosed by ultrasonography and potential liver fibrosis (FIB-4 index ≥1.3) in NAFLD was analyzed in relation to HbA1c level. Factors associated with potential liver fibrosis of NAFLD were also analyzed. RESULTS: The overall frequency of NAFLD was 27.9% (1935 subjects) and the frequency of NAFLD by HbA1c level (<4.9%, 5.0-5.9%, 6.0-6.9%, 7.0-7.9%, ≥8.0%) was 16%, 27%, 54%, 53%, and 54%, respectively. Among the 1935 NAFLD cases, the frequency of potential liver fibrosis was 25.2% (487 subjects) overall and 19%, 22%, 30%, 52%, and 31%, respectively, by HbA1c category. From multivariate analysis, an HbA1c level ≥6.5% was significantly associated with potential liver fibrosis (P = 0.017, hazard ratio = 1.7). CONCLUSIONS: The prevalence of NAFLD and liver fibrosis of NAFLD increased according to glycemia, up to 8.0% HbA1c. Measuring HbA1c and calculating the FIB-4 index in health checkups could help to identify potential cases of liver fibrosis of NAFLD, which should then be further evaluated using other techniques to confirm liver fibrosis.
AIM: The association between glycemia and liver fibrosis was analyzed using hemoglobin A1c (HbA1c) and the Fibrosis-4 (FIB-4) index in a large general population cohort that underwent a health checkup. METHODS: A total of 6927 subjects without hepatitis B or C virus infection or habitual alcohol intake were enrolled. Non-alcoholic fatty liver disease (NAFLD) was diagnosed by ultrasonography and potential liver fibrosis (FIB-4 index ≥1.3) in NAFLD was analyzed in relation to HbA1c level. Factors associated with potential liver fibrosis of NAFLD were also analyzed. RESULTS: The overall frequency of NAFLD was 27.9% (1935 subjects) and the frequency of NAFLD by HbA1c level (<4.9%, 5.0-5.9%, 6.0-6.9%, 7.0-7.9%, ≥8.0%) was 16%, 27%, 54%, 53%, and 54%, respectively. Among the 1935 NAFLD cases, the frequency of potential liver fibrosis was 25.2% (487 subjects) overall and 19%, 22%, 30%, 52%, and 31%, respectively, by HbA1c category. From multivariate analysis, an HbA1c level ≥6.5% was significantly associated with potential liver fibrosis (P = 0.017, hazard ratio = 1.7). CONCLUSIONS: The prevalence of NAFLD and liver fibrosis of NAFLD increased according to glycemia, up to 8.0% HbA1c. Measuring HbA1c and calculating the FIB-4 index in health checkups could help to identify potential cases of liver fibrosis of NAFLD, which should then be further evaluated using other techniques to confirm liver fibrosis.
Authors: Andrea D Coviello; Manal F Abdelmalek; Anastasia-Stefania Alexopoulos; Matthew J Crowley; Ying Wang; Cynthia A Moylan; Cynthia D Guy; Ricardo Henao; Dawn L Piercy; Keri A Seymour; Ranjan Sudan; Dana D Portenier; Anna Mae Diehl Journal: Hepatology Date: 2021-06-02 Impact factor: 17.425