title: Food intake increases liver stiffness measurements and hampers reliable values in patients with chronic hepatitis B and healthy controls: the PROLIFICA experience in The Gambia.
abstract: BACKGROUND
  By increasing the hepatic blood circulation, food intake has been suggested to increase liver stiffness measurement (LSM) values in HCV-infected patients.
  
  
  OBJECTIVE
  To investigate prospectively the effects of food intake on LSM in hepatitis B virus (HBV)-infected patients and healthy controls.
  
  
  METHODS
  In The Gambia, patients included in the PROLIFICA project are screened for HBV at the community level and then invited for fasting assessment including LSM. Between April 2012 and October 2012, each day, the first five participants were invited to participate in this study. After the initial examination, a standardised 850 Kcal breakfast was provided. Effect of food intake was assessed by examining mean difference of LSM, IQR and IQR/LSM at T0 (fasting LSM1), T30min (LSM2) and T120min (LSM3) respectively.
  
  
  RESULTS
  A total of 209 subjects were enrolled in this study (133 were HBV positive, 76 healthy controls). Unreliable measurements occurred more frequently after food intake (5%, 24% and 18% at T0, T30min and T120min respectively). In both groups, median LSM2 was significantly higher than LSM1 [6.2 (IQR: 5.4, 7.9)] vs. 4.9 (4.2, 6.2), P < 0.0001. LSM3 was still higher than the baseline, but lower than LSM2. In multivariable analysis, no factor modified the effect of breakfast on LSM. In a subgroup of patients having liver biopsies, we confirmed that food intake can overestimate liver fibrosis.
  
  
  CONCLUSIONS
  Food intake significantly increases liver stiffness measurement and its IQR values in patients with chronic hepatitis B as well as healthy individuals; and also the number of unreliable liver stiffness measurement values.
authors.affiliation: Medical Research Council, The Gambia Unit, Disease Control and Elimination theme, Liver Unit, Fajara, The Gambia, West-Africa; Department of Hepatology, Imperial College London, St Marys, Norfolk Place, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Lemoine
authors.forename: Y
authors.initials: Y
authors.lastname: Shimakawa
authors.forename: R
authors.initials: R
authors.lastname: Njie
authors.forename: H F
authors.initials: HF
authors.lastname: Njai
authors.forename: S
authors.initials: S
authors.lastname: Nayagam
authors.forename: M
authors.initials: M
authors.lastname: Khalil
authors.forename: R
authors.initials: R
authors.lastname: Goldin
authors.forename: P
authors.initials: P
authors.lastname: Ingiliz
authors.forename: M
authors.initials: M
authors.lastname: Taal
authors.forename: O
authors.initials: O
authors.lastname: Nyan
authors.forename: T
authors.initials: T
authors.lastname: Corrah
authors.forename: U
authors.initials: U
authors.lastname: D'Alessandro
authors.forename: M
authors.initials: M
authors.lastname: Thursz
mesh_terms: D000328:Adult; D004435:Eating; D054459:Elasticity Imaging Techniques; D005260:Female; D005714:Gambia; D019694:Hepatitis B, Chronic / Q000000981:diagnostic imaging*; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged