Liver fat scores do not reflect interventional changes in liver fat content induced by high-protein diets

Stefan Kabisch, Mariya Markova, Silke Hornemann, Stephanie Sucher, Olga Pivovarova-Ramich, Jürgen Machann, Johannes Hierholzer, Sascha Rohn, Andreas F H Pfeiffer, Stefan Kabisch, Mariya Markova, Silke Hornemann, Stephanie Sucher, Olga Pivovarova-Ramich, Jürgen Machann, Johannes Hierholzer, Sascha Rohn, Andreas F H Pfeiffer

Abstract

Non-alcoholic fatty liver disease (NAFLD) is common in Metabolic Syndrome and type 2 diabetes (T2DM), driven by energy imbalance, saturated fats and simple carbohydrates. NAFLD requires screening and monitoring for late complications. Liver fat indices may predict NAFLD avoiding expensive or invasive gold-standard methods, but they are poorly validated for use in interventional settings. Recent data indicate a particular insensitivity to weight-independent liver fat reduction. We evaluated 31 T2DM patients, completing a randomized intervention study on isocaloric high-protein diets. We assessed anthropometric measures, intrahepatic lipid (IHL) content and serum liver enzymes, allowing AUROC calculations as well as cross-sectional and longitudinal Spearman correlations between the fatty liver index, the NAFLD-liver fat score, the Hepatosteatosis Index, and IHL. At baseline, all indices predicted NAFLD with moderate accuracy (AUROC 0.731-0.770), supported by correlation analyses. Diet-induced IHL changes weakly correlated with changes of waist circumference, but no other index component or the indices themselves. Liver fat indices may help to easily detect NAFLD, allowing cost-effective allocation of further diagnostics to patients at high risk. IHL reduction by weight-independent diets is not reflected by a proportional change in liver fat scores. Further research on the development of treatment-sensitive indices is required.Trial registration: The trial was registered at clinicaltrials.gov: NCT02402985.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
AUROC representation of NAFLD prediction by FLI (a), NAFLD-LFS (b) and HSI (c); the analyses show AUROC values of 0.731 (FLI), 0.752 (NAFLD-LFS) and 0.770 (HSI).
Figure 2
Figure 2
Correlation analysis between liver fat indices and IHL at baseline; FLI = fatty liver index, HSI = Hepatosteatosis Index, IHL = intrahepatic lipids, NAFLD-LFS = non-alcoholic fatty liver disease-liver fat score; (a) IHL ~ FLI; rho = 0.351. p = 0.049; (b) IHL ~ NAFLD-LFS; rho = 0.537, p = 0.002; (c) IHL ~ HSI; rho = 0.393, p = 0.032.
Figure 3
Figure 3
Correlation analysis with changes of liver fat indices and IHL; FLI = fatty liver index, HSI = Hepatosteatosis Index, IHL = intrahepatic lipids, NAFLD-LFS = non-alcoholic fatty liver disease-liver fat score; (a) IHL ~ FLI; rho = 0.342. p = 0.069; (b) IHL ~ NAFLD-LFS; rho =  − 0,058, p = 0.765; (c) IHL ~ HSI; rho =  − 0.049, p = 0.800.

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