When the liver gets stiff, the tough get moving

Area of Science:

• Hepatology
• Non-invasive diagnostics
• Lifestyle medicine

Background:

• Liver stiffness measurement (LSM) via transient elastography estimates liver fibrosis severity in non-alcoholic fatty liver disease (NAFLD).
• Cutoffs for advanced fibrosis using LSM in NAFLD are inconsistent, potentially due to steatosis (measured by controlled attenuation parameter [CAP]) and LSM fluctuations.
• Previous studies indicate LSM can reverse in NAFLD patients without advanced fibrosis.

Purpose of the Study:

• To investigate the impact of serial FibroScans and lifestyle modifications on liver stiffness and steatosis in NAFLD patients.
• To determine if weight loss and increased physical activity influence LSM and CAP scores in NAFLD.
• To assess the reliability of a single LSM cutoff for advanced liver fibrosis in NAFLD.

Main Methods:

• Serial FibroScans were performed 6–36 months apart in 73 NAFLD patients, with 38 having LSM > 10 kPa at baseline.
• Patients were grouped based on weight loss (≥ 1 kg) and reported physical activity levels.
• Changes in LSM and CAP scores were compared between groups with and without lifestyle modifications.

Main Results:

• Patients who lost weight (n=31) showed significant reductions in both LSM and CAP scores compared to those who did not.
• Increased physical activity (n=25) also correlated with reduced LSM and CAP scores.
• Improved LSM was significantly associated with weight loss and/or increased physical activity.

Conclusions:

• Lifestyle adjustments, including weight loss and physical activity, can significantly improve liver stiffness and steatosis in NAFLD patients.
• A single LSM measurement of 12.0 kPa is not a reliable cutoff for advanced liver fibrosis in NAFLD due to potential reversibility with lifestyle changes.
• LSM and CAP measurements can motivate NAFLD patients towards beneficial lifestyle modifications, despite reservations about diagnostic accuracy for advanced fibrosis.