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Factors affecting elastography in healthy livers in 20 year old participants of Raine study

Gan, E.K., Olynyk, J., Marsh, J.A. and Adams, L. (2012) Factors affecting elastography in healthy livers in 20 year old participants of Raine study. In: Australian Gastroenterology Week 2012, 16 - 19 October 2012, Adelaide Convention Centre, S.A.


Background Transient elastography non-invasively measures liver fibrosis. Cholestasis, acute inflammation and hepatic congestion increase liver stiffness. There is paucity of data in factors influencing elastography in healthy livers Aims To determine the range and predictive factors of normal liver stiffness in healthy young adults without liver disease in the general population. Methods Liver stiffness measurements (LSM) were assessed using transient elastography in 1241 subjects from the Western Australian Pregnancy (Raine Study) Cohort from May 2010 to March 2012. Assessment included medical questionnaire, alcohol intake, anthropometric measurements, fasting serum liver function and biochemistry. Subjects had previously been screened for fatty liver by abdominal ultrasound. ‘Healthy livers’ were defined according to normal liver enzymes (ALT < 40 U/L males, <35 U/L females, bilirubin <20 μmol/L), absence of ultrasonographic diagnosis of NAFLD at age 17 or prior liver disease. LSM reliability was defined by interquartile range (IQR)/LSM ≤ 0.3, ≥10 valid scans and success rate ≥ 60%. Linear regression was used to determine associations between log transformed LSM and measurements of liver function, indicators of the metabolic syndrome and alcohol intake Results Of the 1241 subjects assessed (634 [51%] males), 337 (27.2%) were excluded due to poor liver health and 46 (3.7%) due to an invalid liver stiffness assessment. Overall the median (range) LSM was 4.8 kPa (4.0–5.7 kPa) and was signifi cantly higher in males than females (5.2 vs 4.4 kPa, p < 2 × 10–16). Other factors significantly (all p < 0.005) associated with log transformed LSM on univariate analysis were height, ALT, ALP, AST, bilirubin, glucose, triglycerides, HDL and total cholesterol, SBP, heart rate, alcohol intake and measures of adiposity (BMI, skinfolds, waist, waist-hip ratio). In the multivariate analysis, male sex (beta = 0.103, p = 0.00002) and heart rate were the most significant factors predicting LSM (HR beta = −0.445 and HR2 beta = 0.002 per 10 beats/min, p = 8 × 10–7 and p = 6 × 10–5, respectively) with male sex associated with increased log LSM and heart rate associated with lower log LSM. Other factors associated with log LSM on multivariate analysis included increased SBP (beta = 0.014 per 5 mmHg p = 0.005), triglycerides (beta = −0.052 per 1 mmol/L; p = 0.026), cholesterol (beta = −0.034 per 1 mmol/L, p = 0.015) and alcohol intake (beta = −0.001 per 10 gms p = 0.001). These factors accounted for 28.4% of the variation in log LSM. Sex-specifi c analyses indicated similar associations in both males and females, although no triglyceride effect was observed in males and no SBP effect was observed in females Conclusion Male sex and low heart rate are significantly associated with higher liver stiffness measurements in the healthy adult population without liver disease. Normal values of liver stiffness should be stratified according to sex and heart rate.

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