title: Utility of noninvasive methods for the characterization of nonalcoholic liver steatosis in the family practice. The "VARES" Italian multicenter study.
abstract: The diagnostic utilities of ultrasonography (US), fatty liver index (FLI) and an algorithm of nine serum markers (Fibromax) were evaluated in family practice to noninvasively characterize patients with nonalcoholic fatty liver disease (NAFLD). A multicenter study was conducted by enrolling 259 consecutively observed patients (age 51 ± 10 years) with clinical and ultrasonographic features of NAFLD . Patients had mild (16.2%), moderate (69.9%), or severe (13.9%) liver steatosis and 60.2% had hypertransaminasemia. The percent of patients with overweight, obesity, diabetes, hypertension, and dyslipidemia were 42.7%, 46.5% (4.2% severe obesity), 24.7%, 40.9%, and 56.4% , respectively. Lean patients (10.8%) had normal transaminases in two/thirds of the cases. A multivariate logistic regression (including age > 50 yrs, BMI > 30 kg/m2, HOMA > 3, and hypertransaminasemia) identified 12.3% of patients at risk for steatohepatitis. With a sensitivity of 50% and specificity of 94.7%, Fibromax identified 34 patients (13.1%) with likely advanced fibrosis and found that over 28% of patients with moderate (ultrasonographic) steatosis were likely to be carrying severe steatosis. Steatotest score was significantly associated with BMI, waist circumference, ALT, triglycerides, and FLI. Fibrotest correlated only with ALT. FLI identified 73.4% of patients as likely to be carrying a fatty liver. In conclusion, NAFLD should be systematically searched and characterized in all patients with metabolic disturbances and cardiovascular risk. Asymptomatic subjects at risk also should be screened for NAFLD. Fibromax is a promising noninvasive diagnostic tool in family medicine for identifying patients at risk for NAFLD who require targeted follow-up.
authors.affiliation: Italian College of General Practitioners, Florence, Italy. igratta@tin.it
authors.forename: Ignazio
authors.initials: I
authors.lastname: Grattagliano
authors.forename: Enzo
authors.initials: E
authors.lastname: Ubaldi
authors.forename: Luigi
authors.initials: L
authors.lastname: Napoli
authors.forename: Carlo Fedele
authors.initials: CF
authors.lastname: Marulli
authors.forename: Cristina
authors.initials: C
authors.lastname: Nebiacolombo
authors.forename: Carmelo
authors.initials: C
authors.lastname: Cottone
authors.forename: Piero
authors.initials: P
authors.lastname: Portincasa
mesh_terms: D000328:Adult; D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D000465:Algorithms; D001219:Aspartate Aminotransferases / Q000097:blood; D015992:Body Mass Index; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005194:Family Practice; D005234:Fatty Liver / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007333:Insulin Resistance; D007558:Italy / Q000453:epidemiology; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014280:Triglycerides / Q000097:blood; D014463:Ultrasonography; D055105:Waist Circumference; D055815:Young Adult
chemical_list: D014280:Triglycerides; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase