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Factors associated with significant liver steatosis and fibrosis as assessed by transient elastography in patients with one or more components of the metabolic syndrome

Background/Aims: We examined the relationship between controlled attenuation parameter (CAP) and liver stiffness measurements (LSM), as assessed by transient elastography (TE), and different clinical and biochemical parameters in patients with one or more components of the metabolic syndrome (MetS). The hypothesis of the study was that LSM and CAP values correlate with the number of MetS components. Methods: In this cross- sectional study a total of 648 consecutive patients were recruited during the years 2013- 2015. Significant liver steatosis was defined as a CAP value≥238 dB/m, whereas significant fibrosis was defined as a LSM value>7.0 kPa. Results: The prevalence of patients with CAP≥238 dB/m and LSM>7.0 kPa were 88.3% and 16.5%, respectively. Patients with CAP≥238 dB/m (n=572) had a markedly higher prevalence of the MetS and all its individual components, as well as higher levels of serum liver enzymes and uric acid compared with those with normal CAP. Moreover, CAP measurements increased progressively with the number of MetS components. Similarly, among patients with CAP≥238 dB/m, those with LSM>7.0 kPa (n=103) had higher serum liver enzymes and a greater prevalence of the MetS and its individual components than those with LSM≤7.0 kPa. In multivariable regression analysis the factors independently associated with elevated CAP were the presence of the MetS (or its individual components), insulin resistance (defined by HOMA-IR score), increased serum uric acid and LSM>7 kPa. Similarly, the MetS (or its individual components), insulin resistance and increased serum uric acid levels were also independently associated with LSM>7.0 kPa. Conclusions: Patients with one or more MetS components have a high prevalence of NAFLD and advanced liver fibrosis. LSM and CAP correlate with the number of MetS components.

metabolic syndrome ; controlled attenuation parameter ; liver stiffness measurement ; non-alcoholic fatty liver disease

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