Dataset Information

Distribution of FIB-4 index in the general population: analysis of 75,666 residents who underwent health checkups.

ABSTRACT:

Background

Fatty liver is frequently found in a general population, and it is critical to detect advanced fibrosis. FIB-4 index is considered a useful marker for evaluating liver fibrosis but the distribution of FIB-4 index in the general population remains unknown.

Methods

This cross-sectional study included residents who underwent ultrasonography at health checkups in Hiroshima or Iwate prefectures. The distribution of FIB-4 index in the total study population (N = 75,666) as well as in non-alcoholic fatty liver disease (NAFLD) populations (N = 17,968) and non-drinkers without fatty liver populations (N = 47,222) was evaluated. The distribution of aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT) levels was also evaluated.

Results

The mean FIB-4 index in the total study population was 1.20 ± 0.63. FIB-4 index ≥ 2.67, which indicates a high risk of liver fibrosis, was found in 16.4% of those aged ≥ 70 years. In the NAFLD population, 58.1% of those in their 60 s and 88.1% of those ≥ 70 years met the criteria for referral to hepatologists by using the recommended FIB-4 index cutoff value (≥ 1.3). The mean FIB-4 index in the NAFLD population (1.12 ± 0.58) was significantly lower than in the non-drinkers without fatty liver (1.23 ± 0.63, p < 0.0001). The non-drinkers without fatty liver tended to have higher AST relative to ALT levels (60.0% with AST/ALT > 1.0), whereas the results in the NAFLD population were opposite (14.8% with AST/ALT > 1.0). AST > ALT resulted in a higher FIB-4 index in non-drinkers without fatty liver due to the nature of FIB-4 index formula.

Conclusions

The cutoff value of FIB-4 index (≥ 1.3) for triaging the elderly people with fatty liver for referral to hepatologists should be reconsidered to avoid over-referral. Due to the impact of age and characteristics of AST/ALT ratios, there is no prospect of using FIB-4 index for primary screening for liver fibrosis in a general population of unknown presence or absence of liver disease, even though it can be easily calculated using routine clinical indices. It is desired to develop a non-invasive method for picking up cases with advanced fibrosis latent in the general population.

SUBMITTER: Sugiyama A

PROVIDER: S-EPMC9101936 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

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Publications

Distribution of FIB-4 index in the general population: analysis of 75,666 residents who underwent health checkups.

Sugiyama Aya A Kurisu Akemi A E Bunthen B Ouoba Serge S Ko Ko K Rakhimov Anvarjon A Akita Tomoyuki T Harakawa Takayuki T Sako Toru T Koshiyama Makoto M Kumada Takashi T Tanaka Junko J

BMC gastroenterology 20220513 1

<h4>Background</h4>Fatty liver is frequently found in a general population, and it is critical to detect advanced fibrosis. FIB-4 index is considered a useful marker for evaluating liver fibrosis but the distribution of FIB-4 index in the general population remains unknown.<h4>Methods</h4>This cross-sectional study included residents who underwent ultrasonography at health checkups in Hiroshima or Iwate prefectures. The distribution of FIB-4 index in the total study population (N = 75,666) as we ...[more]

PMID: 35562658

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Project description:ImportanceType 2 diabetes and hypertension are obesity-related, noncommunicable diseases becoming increasingly common worldwide. In 2008, Japan launched a nationwide universal health checkup program, Specific Health Checkup (SHC), for the primary prevention of obesity-related diseases, but its effectiveness has been understudied.ObjectiveTo investigate the association of the SHC program with incident diabetes and hypertension, using a target trial emulation framework.Design, setting, and participantsThis retrospective cohort study used data from a longitudinal health care database involving both checkup history and medical encounter records in Japan. Individuals aged 40 to 74 years, without diabetes or hypertension, and without a prior checkup history, were eligible. Individuals were repeatedly assessed for eligibility from April 1, 2008, to March 31, 2020, to assemble sequential cohorts of 78 620 SHC participants and 214 554 nonparticipants. Statistical analysis was conducted from June 8 to December 30, 2023.Main outcomes and measuresThe composite risk of incident type 2 diabetes or hypertension over a period of up to 10 years, defined as the combination of a newly documented diagnosis and use of relevant medications. A propensity score-weighted survival analysis was conducted to adjust for baseline variables. A series of sensitivity analyses and a negative outcome control analysis were conducted using depression as a benchmark.ResultsSequential cohorts consisted of 78 620 SHC participants (median age, 46 years [IQR, 41-53 years]; 62.7% women) and 214 554 nonparticipants (median age, 49 years [IQR, 44-55 years]; 82.0% women) from 153 084 unique persons, each of whom entered the study cohort a mean (SD) of 1.9 (1.5) times. Within a median follow-up of 4.2 years (IQR, 2.7-6.3 years), the primary end point occurred among 11.2% of all individuals (10.6% of the SHC participants and 11.4% of the nonparticipants), with a lower hazard ratio (HR) among the SHC recipients (HR, 0.90; 95% CI, 0.89-0.92); the difference in cumulative incidence at 10 years was -1.6% (95% CI, -1.8% to -1.3%). The sensitivity analyses showed similar results. The negative control analysis suggested the potential for residual confounding (HR, 1.05; 95% CI, 1.02-1.07); the bias-calibrated HR was 0.86 (95% CI, 0.84-0.89) for the primary outcome.Conclusions and relevanceIn this cohort study, within a median of 4.2 years of follow-up, SHC recipients had a 9.8% lower risk of incident diabetes and hypertension (13.8% in the bias-calibrated analysis). The cost-effectiveness of the SHC and its transportability to other regions are unclear, requiring future investigations.

Dataset Information

Distribution of FIB-4 index in the general population: analysis of 75,666 residents who underwent health checkups.

Background

Methods

Results

Conclusions

Publications

Distribution of FIB-4 index in the general population: analysis of 75,666 residents who underwent health checkups.

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