The Journal of Medical Sciences

Register      Login

VOLUME 10 , ISSUE 1--4 ( January-December, 2024 ) > List of Articles

RESEARCH ARTICLE

Multivariate Analysis of Predictive Scores for Severity Prediction in Nonalcoholic Fatty Liver Disease Among Obese and Nonobese Patients

Suvankar Dey, Bandita Panda, Ambika P Mohanty

Keywords : Body mass index, Diabetes, Homeostatic model assessment of insulin resistance, Nonalcoholic fatty liver disease fibrosis, Nonalcoholic fatty liver disease

DOI: 10.5005/jp-journals-10045-00292

License: CC BY-NC 4.0

Published Online: 30-09-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: Insulin resistance is a common factor in nonalcoholic fatty liver disease (NAFLD). The study compares the clinicodemographic and metabolic features of NAFLD among obese and nonobese patients and analyzes predictive scores for better prediction and prognosis. Materials and methods: A prospective observational study was conducted in 180 NAFLD patients. Obese and nonobese patients with NAFLD were compared for clinicodemographic and metabolic features. Disease severity was assessed by homeostatic model assessment of insulin resistance (HOMA-IR), body mass index (BMI), age, and the presence of diabetes (BARD), aspartate aminotransferase (AST) to platelet ratio index (APRI), and fibrosis-4 (FIB-4) scores and analyzed statistically by multivariate regression analysis. Results: Mean age ranged between 42.31 and 46.65 years. Of the 180 NAFLD patients, 69.44% were obese (BMI >25), 14.44% were lean, and 16.11% were overweight; the rest were nonobese patients. Patients with a BMI <22.9 were grouped as lean, and those with a BMI between 23 to 25 were categorized as overweight. In metabolic profile no significant change was observed among obese and non-obese between obese and nonobese patients. In the severity assessment, HOMA-IR and NAFLD fibrosis scores were significantly higher in obese patients than in lean patients of the nonobese group. Multivariate regression analysis of HOMA-IR, BARD, NAFLD fibrosis, and controlled attenuation parameter (CAP) scores suggested a linear regression equation with predictors HOMA-IR, BARD, CAP, and BMI. The specificity and sensitivity of HOMA-IR and BARD scores were 0.67. Conclusion: Nonobese (lean and overweight) and obese patients have a common set of metabolic profiles except for BMI, impaired glucose tolerance, and insulin resistance. For severity assessment, HOMA-IR and NAFLD fibrosis scores can be comparable among nonobese (lean and overweight) and obese patients, and for ultrasonography (USG), CAP can be considered a suitable marker for both obese and lean patients.


PDF Share
  1. Sinha N, Mukhopadhyay S, Sau M. Metabolic syndrome is not uncommon among lean non-alcoholic fatty liver disease patients as compared with those with obesity. Indian J Gastroenterol 2020;39(1):75–83. DOI: 10.1007/s12664-020-01020-3
  2. Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016;64(1):73–84. DOI: 10.1002/hep.28431
  3. Hareesh GJ, Ramadoss R. Clinical profile, short-term prognostic accuracies of CLIF-C ACLF Score and Serial CLIF-C OF scores in acute-on-chronic liver failure patients: a prospective observational study. Indian J Crit Care Med 2024;28(2):126–133. DOI: 10.5005/jp-journals-10071-24640
  4. Saluja V, Sharma A, Pasupuleti SS, et al. Comparison of prognostic models in acute liver failure: decision is to be dynamic. Indian J Crit Care Med 2019;23(12):574–581. DOI: 10.5005/jp-journals-10071-23294
  5. Younossi Y, Mir H, Srishord M. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol 2011;9(6):524–530.e1. DOI: 10.1016/j.cgh.2011.03.020
  6. Seto WK, Yuen MF. Nonalcoholic fatty liver disease in Asia: emerging perspectives. J Gastroenterol 2017;52:164–174. DOI: 10.1007/s00535-016-1264-3
  7. Estes C, Razavi H, Loomba R, et al. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology 2018;67(1):123–133. DOI: 10.1002/hep.29466
  8. Seyda Seydel G, Kucukoglu O, Altinbasv A, et al. Economic growth leads to increase of obesity and associated hepatocellular carcinoma in developing countries. Ann Hepatol 2016;15(5):662–672. DOI: 10.5604/16652681.1212316
  9. Li D, Zhang M, Wu S. Risk factors and prediction model for nonalcoholic fatty liver disease in northwest China. Sci Rep 2022;12:13877. DOI: 10.1038/s41598-022-17511-6
  10. Barzilai N, Huffman DM, Muzumdar RH, et al. The critical role of metabolic pathways in aging. Diabetes 2012;61:1315–1322. DOI: 10.2337/db11-1300
  11. Younossi ZM, Stepanova M, Negro F, et al. Nonalcoholic fatty liver disease in lean individuals in the United States. Medicine (Baltimore) 2012;91(6):319–327. DOI: 10.1097/MD.0b013e3182779d49
  12. Shah P, Rathi P, Mandot A, et al. Study and comparison of metabolic profile of lean and obese subjects with non alcoholic fatty liver disease. J Assoc Physicians India 2020;68(8):51–54.
  13. Young S, Tariq R, Provenza J, et al. Prevalence and profile of nonalcoholic fatty liver disease in lean adults: systematic review and meta-analysis. Hepatol Commun 2020;4(7):953–972. DOI: 10.1002/hep4.1519
  14. Rastogi A, Shasthry SM, Agarwal A, et al. Non-alcoholic fatty liver disease - histological scoring systems: a large cohort single-center, evaluation study. APMIS 2017;125(11):962–973. DOI: 10.1111/apm.12742
  15. Feng R, Luo C, Li C, et al. Free fatty acids profile among lean, overweight and obese non-alcoholic fatty liver disease patients: a case - control study. Lipids Health Dis 2017;16(1):165. DOI: 10.1186/s12944-017-0551-1
  16. Machado MV. Nonalcoholic fatty liver disease in lean subjects: is it all metabolic-associated fatty liver disease? Hepatoma Res 2020;6:84. DOI: 10.20517/2394-5079.2020.90
  17. Gayoso-Diz P, Otero-González A, Rodriguez-Alvarez MX, et al. Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study. BMC Endocr Disord 2013;13:47. DOI: 10.1186/1472-6823-13-47
  18. Treeprasertsuk S, Björnsson E, Enders F, et al. NAFLD fibrosis score: a prognostic predictor for mortality and liver complications among NAFLD patients. World J Gastroenterol 2013;19(8):1219–1229. DOI: 10.3748/wjg.v19.i8.1219
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.