Global Liver Health Forum: New noninvasive tests provide a more accurate diagnosis of liver fibrosis

NAFLD (non-alcoholic fatty liver disease) encounters metabolic disorders, the risk of liver fibrosis increases, and Professor Fan Jiangao, a mainland liver disease expert, pointed out that the new non-invasive detection tool can provide a more accurate diagnosis for patients with advanced liver fibrosis.

On October 22, 2021, at the second Global Liver Health Forum hosted by Sanofi Global Medicine, experts from the five countries conducted in-depth discussions on the theme of liver health.

Professor Fan Jiangao of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, China, introduced China's achievements in the field of liver disease assessment and treatment, as well as the new non-invasive diagnostic tool (MetDis).

The meeting was moderated by Ms. Donna Cryer, Global Liver Institute, Washington, D.C., USA. Professor Fan Jiangao, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, China, Professor Gert Fricker, Institute of Pharmacy and Molecular Biotechnology, Heidelberg University, Germany, Professor Chavdar Pavlov, Director of the Center for Evidence-Based Medicine, Sechenov, First Moscow State Medical University, Russia, and Professor Alexander V. Nersesov, Department of Gastroenterology, National Institute of Cardiology and Internal Medicine of Kazakhstan, respectively delivered keynote speeches.

Metabolic abnormalities are strongly associated with NAFLD

According to the guidelines of the International Diabetes Federation (2005), MetS (metabolic syndrome) consists of concentric obesity plus any of the following 2 metabolic disorders: elevated triglycerides, decreased high-density lipoprotein cholesterol (HDL-C), elevated blood pressure, or increased fasting blood glucose.

Nonalcoholic fatty liver disease (NAFLD) is closely associated with features of MetS, such as insulin resistance, hyperglycemia, obesity, and dyslipidemia. Patients with obesity, elevated fasting blood glucose, T2DM (type 2 diabetes mellitus), or other metabolic abnormalities are at increased risk of developing advanced liver fibrosis compared with patients without metabolic abnormalities. To this end, the 2020 International Panel of Experts renamed NAFLD to Metabolic-Associated Fatty Liver Disease (MAFLD).

The MetDis noninvasive diagnostic tool promises to be an effective screening method

Since 2016, the Department of Gastroenterology of Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine has led more than ten hospitals across the country to pass prospective cross-sectional clinical studies (Towards studies)[1], and of the 246 patients included in the TOWARDS study, 239 (97.2%) met the diagnostic criteria for MAFLD, while fewer patients with NASH (steatohepatitis) did not meet the diagnostic criteria for MAFLD (43.9% vs 86.4%). This suggests that the presence of MetS is more correlated with the severity of steatohepatitis and fibrosis.

Patients with MetS had higher histologic scores for lobular inflammation, balloon changes, and fibrosis compared with those without MetS. In 246 patients with NAFLD, as the number of metabolic syndrome components increased, the proportion of non-alcoholic steatohepatitis (NASH) and significant hepatic fibrosis increased significantly.

In addition, the findings suggest that the severity of insulin resistance may indicate progression in steatohepatitis and liver fibrosis. The results showed that metabolic disorders exacerbated the severity of liver fibrosis in patients with NAFLD, and metabolic disorder factors should be taken into account in the diagnosis and management of the disease.

Based on the above research, the research team developed a new noninvasive diagnostic tool (MetDis), that is, the use of HDL-C reduction and fasting blood glucose increase as a screening tool for advanced fibrosis. Further studies found that by combining MetDis with a standard non-invasive test FIB-4 (fibrosis-4) index, it had a highly negative predictive value with a sensitivity of 92%, a specificity of 81%, and an accuracy of 83%.

Compared with FIB-4 alone, the number of patients requiring liver biopsy decreased (36% vs 17%, p>

Note: The FIB-4 index noninvasive assessment of liver fibrosis in patients with chronic liver disease is calculated as follows:

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Liver disease experts from various countries have demonstrated new perspectives on the treatment of liver disease

Professor Gert Fricker, Institute of Pharmacy and Molecular Biotechnology, Heidelberg University, Germany:

EPL (Essential Phospholipids) is a high-purity extract of soy polyene phosphatidylcholine (PPC) that significantly improves the PC (phosphatidylcholine), PC (phosphatidylcholine)/PE (phosphatidylcholine) ratios of normal and steatode hepatocyte lines, thereby increasing hepatocyte membrane fluidity, reducing apoptosis, and increasing hepatocyte transport[2]. These may be the mechanisms by which EPL has improved liver function and liver-protecting effects when used as an adjunctive therapy for MAFLD.

Professor Chavdar Pavlov, Director of the Department of Evidence-Based Medicine and Director of the Center for Evidence-Based Medicine at Sechenov State Medical University, First Moscow State Medical University, Russia:

The results of an observational, multicenter study of MANPOWER published in BMJ Open Gastroenterology (2019–2020) showed that patients with NAFLD treated with cardiometabolic comorbidities were treated with EPL for 24 weeks, and 74.9% of the 2843 metabolically associated fatty liver patients enrolled were simple steatosis When the investigators recommended dietary and lifestyle interventions for these patients according to the guidelines, only 13.8% of the patients followed the requirements of a controlled diet and had poor compliance; ultrasound results improved significantly after 3.6 months of EPL treatment; and ALT, AST, and GGT (p) after 3 and 6 months of treatment