- Email: [email protected]
P1018 : Significant correlation between visceral fat area and controlled attenuation parameter
POSTERS P1017 CIRCULATING SCLEROSTIN AND DICKKOPF-1 IN PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE S.A. Polyzos1 , A.D. Anastasilakis2 , E. Terpos3 , P. Makras4 , A. Papatheodorou5 , P. Kokkoris5 , J. Kountouras1 . 1 Second Medical Clinic, Aristotle University of Thessaloniki, 2 Endocrinology, 424 General Military Hospital, Thessaloniki, 3 Department of Clinical Therapeutics, University of Athens School of Medicine, 4 Endocrinology and Diabetes, 5 Medical Research, 251 Hellenic Air Force & VA General Hospital, Athens, Greece E-mail: [email protected] Background and Aims: There is evidence for possible bidirectional interplay between hepatic and bone metabolism. The primary aim of this study was to evaluate the serum sclerostin and dickkopf (DKK)-1 levels in patients with nonalcoholic fatty liver disease (NAFLD), untreated for metabolic bone disease, and their association with the disease severity. Methods: Thirteen and 14 patients with biopsy-proven nonalcoholic simple steatosis (SS) and steatohepatitis (NASH), respectively, and 20 controls of similar gender, age, body mass index (BMI) and waist circumference (WC) were consecutively enrolled. Serum sclerostin, DKK-1, bone-specific alkaline phosphatase (BALP), carboxy-terminal telopeptides of Type I collagen (CTX), 25-hydroxy vitamin D [25(OH)D] and insulin, as well as standard biochemical and hematologic tests were measured. Lumbar spinal (LS) dual energy X-ray absorptiometry (DXA) was also performed. Results: There was a trend towards decrease in serum sclerostin levels from the controls (76.1±6.8) to SS (53.5±6.4) and NASH (46.0±8.1 pmol/l) patients (p = 0.009); in adjusted pairwise comparisons (Bonferroni correction), sclerostin was significantly higher in the controls than NASH patients (p = 0.012), whereas not statistically different between controls and SS (p = 0.091), or SS and NASH patients (p = 1.0). Serum DKK-1 did not differ between groups (p = 0.135), though it showed a trend for U-shaped distribution (controls 35.8±2.8; SS 27.3±2.9; NASH 36.8±4.4 pmol/l). There was not between group differences in age, BMI, WC, BALP, CTX, 25(OH)D, and LS DXA, whereas liver function tests, insulin and insulin resistance, as expected, were progressively increased from the controls to SS and NASH. After adjustment for gender, BMI, age, log(alanine aminotransferase), CTX, white blood cells and erythrocyte sedimentation rate, between group differences remained significant for sclerostin, and non-significant for DKK-1. Regarding specific histological lesions, DKK-1 levels were marginally lower in NAFLD patients with lower (≤33%) steatosis grade (27.7±3.1) than those with steatosis >33% (38.8±4.7 pmol/l; p = 0.049). No statistically significant differences of sclerostin or DKK-1 were observed in fibrosis grade, portal or lobular inflammation or ballooning. Conclusions: Serum sclerostin levels were lower in NASH patients compared to the controls, whereas similar DKK-1 levels were observed between groups. These findings warrant further research. P1018 SIGNIFICANT CORRELATION BETWEEN VISCERAL FAT AREA AND CONTROLLED ATTENUATION PARAMETER K.S. Jung1 , K.J. Kim2 , J.Y. Park1 , Y.E. Chon1 , B.K. Kim1 , S.U. Kim1 , D.Y. Kim1 , S.H. Ahn1 , K.-H. Han1 . 1 Department of Internal Medicine, 2 Division of Endocrinology, Yonsei University College of Medicine, Seoul, Korea, South E-mail: [email protected] Background and Aims: This study is designed to investigate the relationship between controlled attenuation parameter (CAP) and visceral fat area (VFA). Methods: A total of 304 consecutive patients who underwent both of transient elastography and abdominal fat CT during regular health check up at one tertiary center in Korea were enrolled
prospectively. To obtain VFA, the visceral and peripheral adipose regions were calculated according to the intervertebral position of L4–5. Clinical, metabolic measurement, and laboratory data were also evaluated. In this study, significant steatosis is defined when CAP value is ≥250 dB/m. Results: The mean age (165 male, 139 female) was 56.5 years and mean body mass index (BMI) was 24.1 kg/m2 . Twentytwo patients (7.2%) had diabetes mellitus and 44 (14.5%) had hypertension. In univariate analysis, the patients with significant hepatic steatosis had higher BMI, waist/hip ratio, VFA, peripheral fat area, fasting glucose level, triglyceride (TG) level, and alanine aminotransferase (ALT) levels (all P < 0.05). In multivariate analysis, VFA (odds ratio [OR] 1.010; 95% confidence interval [CI] 1.001– 1.019; P = 0.028) and TG (OR 1.006; 95% CI 1.001–1.011; P = 0.022) were selected as independent risk factor for significant hepatic steatosis. When the study population was stratified into three groups (VFA ≤100 cm2 , VFA 100.1–200 cm2 , VFA >200 cm2 ), patients with a higher VFA were at a greater risk of significant hepatic steatosis with OR 4.838 (P < 0.001; 95% CI 2.912–8.039) for VFA 100.1–200 cm2 ; OR 7.474 (P < 0.001; 95% CI 2.462–22.693) for VFA >200 cm2 . In sub analysis of 110 patients with BMI <23 kg/m2 , only VFA was significantly related with hepatic steatosis (OR 1.006; 95% CI 1.001–1.011; P = 0.022). Conclusions: Our data demonstrated that VFA was significantly related with significant hepatic steatosis assessed by CAP, suggesting that surveillance of hepatic steatosis is needed for patients with central obesity. P1019 THE IMPACT OF METABOLIC SYNDROME ON ALT LEVELS AMONG THE LARGE MULTIETHNIC COHORT OF NORTH AMERICAN PATIENTS WITH CHRONIC HEPATITIS B INFECTION ENROLLED IN THE HEPATITIS B RESEARCH NETWORK (HBRN) M. Khalili1 , M. Lombardero2 , J. Feld3 , M. Shuhart4 , R. Chung5 , N. Terrault1 , K. Kowdley6 , M. Lisker-Melman7 , M. Ghany8 , W.R. Kim9 , A. Sanyal10 , A. Lok11 , Hepatitis B Research Network (HBRN). 1 University of California San Francisco, San Francisco, 2 University of Pittsburgh, Pittsburgh, United States; 3 University of Toronto, Toronto, Canada; 4 University of Washington, Seattle, 5 Massachusetts General Hospital, Boston, 6 Swedish Medical Center, Seattle, 7 Washington University, St. Louis, 8 National Institutes of Health, Bethesda, 9 Stanford University, Palo Alto, 10 Virginia Commonwealth University, Richmond, 11 University of Michigan, Michigan, United States E-mail: [email protected] Background and Aims: Due to rise in obesity, metabolic syndrome (MS) is prevalent in western countries affecting about 25% of adults in United States. MS is associated with adverse liver disease outcomes including disease progression and hepatocellular carcinoma (HCC). However, the impact of MS on liver disease markers among patients with chronic hepatitis B infection (CHB) living in North America (NA) have not been well studied. We sought to determine the prevalence of MS and its influence on ALT levels at cohort entry and change in ALT over time in a large multi-ethnic NA cohort of patients infected with HBV. Methods: Adult patients with CHB (HBsAg+ >6 months) who were not pregnant and without liver decompensation, HCC, liver transplant, HIV or current antiviral therapy from 21 US/Canada centers were evaluated. MS was defined as presence of at least 3 of the 5 standard criteria including high population-based waist circumference, blood pressure, glucose and triglyceride levels, and low HDL. Data were assessed at baseline and ALT and HBV DNA were followed over a median of 2.3 years. Results: 973 patients were included in the analysis: median age 43 yrs, 48% female, 73% Asian (12% black, 11% white), and 82% were born outside US/Canada (28% migrated >20 yrs ago). Participants had a mean of 3 ALT measurements. MS was present in 20% and
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prospectively. To obtain VFA, the visceral and peripheral adipose regions were calculated according to the intervertebral position of L4–5. Clinical, metabolic measurement, and laboratory data were also evaluated. In this study, significant steatosis is defined when CAP value is ≥250 dB/m. Results: The mean age (165 male, 139 female) was 56.5 years and mean body mass index (BMI) was 24.1 kg/m2 . Twentytwo patients (7.2%) had diabetes mellitus and 44 (14.5%) had hypertension. In univariate analysis, the patients with significant hepatic steatosis had higher BMI, waist/hip ratio, VFA, peripheral fat area, fasting glucose level, triglyceride (TG) level, and alanine aminotransferase (ALT) levels (all P < 0.05). In multivariate analysis, VFA (odds ratio [OR] 1.010; 95% confidence interval [CI] 1.001– 1.019; P = 0.028) and TG (OR 1.006; 95% CI 1.001–1.011; P = 0.022) were selected as independent risk factor for significant hepatic steatosis. When the study population was stratified into three groups (VFA ≤100 cm2 , VFA 100.1–200 cm2 , VFA >200 cm2 ), patients with a higher VFA were at a greater risk of significant hepatic steatosis with OR 4.838 (P < 0.001; 95% CI 2.912–8.039) for VFA 100.1–200 cm2 ; OR 7.474 (P < 0.001; 95% CI 2.462–22.693) for VFA >200 cm2 . In sub analysis of 110 patients with BMI <23 kg/m2 , only VFA was significantly related with hepatic steatosis (OR 1.006; 95% CI 1.001–1.011; P = 0.022). Conclusions: Our data demonstrated that VFA was significantly related with significant hepatic steatosis assessed by CAP, suggesting that surveillance of hepatic steatosis is needed for patients with central obesity. P1019 THE IMPACT OF METABOLIC SYNDROME ON ALT LEVELS AMONG THE LARGE MULTIETHNIC COHORT OF NORTH AMERICAN PATIENTS WITH CHRONIC HEPATITIS B INFECTION ENROLLED IN THE HEPATITIS B RESEARCH NETWORK (HBRN) M. Khalili1 , M. Lombardero2 , J. Feld3 , M. Shuhart4 , R. Chung5 , N. Terrault1 , K. Kowdley6 , M. Lisker-Melman7 , M. Ghany8 , W.R. Kim9 , A. Sanyal10 , A. Lok11 , Hepatitis B Research Network (HBRN). 1 University of California San Francisco, San Francisco, 2 University of Pittsburgh, Pittsburgh, United States; 3 University of Toronto, Toronto, Canada; 4 University of Washington, Seattle, 5 Massachusetts General Hospital, Boston, 6 Swedish Medical Center, Seattle, 7 Washington University, St. Louis, 8 National Institutes of Health, Bethesda, 9 Stanford University, Palo Alto, 10 Virginia Commonwealth University, Richmond, 11 University of Michigan, Michigan, United States E-mail: [email protected] Background and Aims: Due to rise in obesity, metabolic syndrome (MS) is prevalent in western countries affecting about 25% of adults in United States. MS is associated with adverse liver disease outcomes including disease progression and hepatocellular carcinoma (HCC). However, the impact of MS on liver disease markers among patients with chronic hepatitis B infection (CHB) living in North America (NA) have not been well studied. We sought to determine the prevalence of MS and its influence on ALT levels at cohort entry and change in ALT over time in a large multi-ethnic NA cohort of patients infected with HBV. Methods: Adult patients with CHB (HBsAg+ >6 months) who were not pregnant and without liver decompensation, HCC, liver transplant, HIV or current antiviral therapy from 21 US/Canada centers were evaluated. MS was defined as presence of at least 3 of the 5 standard criteria including high population-based waist circumference, blood pressure, glucose and triglyceride levels, and low HDL. Data were assessed at baseline and ALT and HBV DNA were followed over a median of 2.3 years. Results: 973 patients were included in the analysis: median age 43 yrs, 48% female, 73% Asian (12% black, 11% white), and 82% were born outside US/Canada (28% migrated >20 yrs ago). Participants had a mean of 3 ALT measurements. MS was present in 20% and
Journal of Hepatology 2015 vol. 62 | S263–S864
S729