An extended fatty liver index to predict non-alcoholic fatty liver disease - 13/01/17

Doi : 10.1016/j.diabet.2016.11.006

K. Kantartzis ^a,^b,^c, I. Rettig ^a, H. Staiger ^a,^b,^c, J. Machann ^c,^d, F. Schick ^c,^d, L. Scheja ^e, A. Gastaldelli ^f, E. Bugianesi ^g, A. Peter ^a,^b,^c, M.B. Schulze ^c,^h, A. Fritsche ^a,^b,^c, H.-U. Häring ^a,^b,^c, N. Stefan ^a,^⁎,^b,^c
^a Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, University of Tübingen, Otfried-Müller Street 10, 72076 Tübingen, Germany
^b Institute for Diabetes Research and Metabolic Diseases (IDM), Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany
^c German Center for Diabetes Research (DZD), Neuherberg, Germany
^d Section on Experimental Radiology, University of Tübingen, Tübingen, Germany
^e Department of Biochemistry and Molecular Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
^f Institute of Clinical Physiology National Research Council, Pisa, Italy
^g Division of Gastroenterology, Department of Medical Sciences, University of Torino, Torino, Italy
^h Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany

^⁎Corresponding author. Tel.: +49 7071 2980390; fax: +49 7071 295974.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 13 January 2017

Abstract

Background

In clinical practice, there is a strong interest in non-invasive markers of non-alcoholic fatty liver disease (NAFLD). Our hypothesis was that the fold-change in plasma triglycerides (TG) during a 2-h oral glucose tolerance test (fold-change TG_OGTT) in concert with blood glucose and lipid parameters, and the rs738409 C>G single nucleotide polymorphism (SNP) in PNPLA3 might improve the power of the widely used fatty liver index (FLI) to predict NAFLD.

Methods

The liver fat content of 330 subjects was quantified by ¹H-magnetic resonance spectroscopy. Blood parameters were measured during fasting and after a 2-h OGTT. A subgroup of 213 subjects underwent these measurements before and after 9 months of a lifestyle intervention.

Results

The fold-change TG_OGTT was closely associated with liver fat content (r=0.51, P<0.0001), but had less power to predict NAFLD (AUROC=0.75) than the FLI (AUROC=0.79). Not only was the fold-change TG_OGTT independently associated with liver fat content and NAFLD, but so also were the 2-h blood glucose level and rs738409 C>G SNP in PNPLA3. In fact, a novel index (extended FLI) generated from these and the usual FLI parameters considerably increased its power to predict NAFLD (AUROC=0.79–0.86). The extended FLI also increased the power to predict changes in liver fat content with a lifestyle intervention (n=213; standardized beta coefficient: 0.23–0.29).

Conclusion

This study has provided novel data confirming that the OGTT-derived fold-change TG_OGTT and 2-h glucose level, together with the rs738409 C>G SNP in PNPLA3, allow calculation of an extended FLI that considerably improves its power to predict NAFLD.

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Keywords : Fatty liver, Lifestyle intervention, NAFLD, OGTT, Prediction, Triglycerides