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What Is the Role of the New Index Relative Fat Mass (RFM) in the Assessment of Nonalcoholic Fatty Liver Disease (NAFLD)?

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Abstract

Introduction

Nonalcoholic fatty liver disease (NAFLD) is the liver manifestation of adiposopathy. Recently, a new score was developed to estimate body fat percentage (relative fat mass, RFM). We aimed to evaluate the value of RFM in predicting the presence and severity of NAFLD, compared with other anthropometric measurements.

Methods

RFM, body mass index (BMI), and other anthropometric measurements were evaluated in two cohorts of subjects: a cohort from a Portuguese prospective epidemiological study (e_Cor) and morbidly obese patients with biopsy-proven NAFLD. We evaluated if RFM and BMI were related with the presence and severity of liver disease, which was assessed by noninvasive tools in the first cohort and by liver histology in the morbidly obese cohort. The independence of relations found in univariate analysis was assessed with multivariable logistic regression analysis.

Results

In the general population cohort, 744 subjects (48% male) were enrolled. BMI-defined obesity was present in 23% and RFM-defined obesity in 86%. Insulin resistance (IR) related with BMI-defined obesity (OR 4.37 [2.16–8.84]) and weight (OR 1.05 [1.02–1.08]) in men, and waist circumference (WC) (OR 1.07 [1.03–1.11]) in women. Dyslipidemia and hypertension related with RFM-defined obesity in men (OR 2.96 [1.36–6.47] and OR 5.37 [1.31–22.06], respectively). Ultrasound-diagnosed NAFLD in 33% related with weight in men (OR 1.03 [1.003–1.06] and WC in women (OR 1.06 [1.02–1.10]). In men, ALT elevation related with weight (OR 1.04 [1.02–1.07]). In women, advanced fibrosis (estimated by NAFLD Fibrosis Score) associated with BMI-defined obesity (OR 42.43 [3.61–498.13]). In the morbidly obese cohort, 152 subjects were enrolled, of whom 84% were female, 37% had steatohepatitis, and 9.4% had advanced fibrosis. Adiponectin associated inversely and leptin positively with RFM in men. The severity of steatosis increased linearly with BMI and WC in women. Higher BMI associated with steatohepatitis in women and advanced fibrosis in men.

Conclusion

RFM-defined obesity better predicted dyslipidemia and hypertension (though not IR) and adipokine imbalance; however, it did not add value to BMI-defined obesity in predicting NAFLD or liver injury.

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Abbreviations

ALT:

Alanine aminotransferase

BMI:

Body mass index

DXA:

Dual-energy X-ray absorptiometry

ELISA:

Enzyme-linked immunosorbent assay

HOMA-IR:

Homeostasis model assessment of insulin resistance

IR:

Insulin resistance

NAFLD:

Nonalcoholic fatty liver disease

RFM:

Relative fat mass

WC:

Waist circumference

References

  1. Estes C, Anstee QM, Arias-Loste MT, et al. Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016-2030. J Hepatol. 2018;69(4):896–904.

    Article  Google Scholar 

  2. Machado MV, Diehl AM. Pathogenesis of nonalcoholic steatohepatitis. Gastroenterology. 2016;150(8):1769–77.

    Article  CAS  Google Scholar 

  3. Li L, Liu DW, Yan HY, et al. Obesity is an independent risk factor for non-alcoholic fatty liver disease: evidence from a meta-analysis of 21 cohort studies. Obes Rev. 2016;17(6):510–9.

    Article  CAS  Google Scholar 

  4. Non-alcoholic Fatty Liver Disease Study G, Lonardo A, Bellentani S, et al. Epidemiological modifiers of non-alcoholic fatty liver disease: focus on high-risk groups. Dig Liver Dis. 2015;47(12):997–1006.

    Article  Google Scholar 

  5. Ryan DH, Kahan S. Guideline recommendations for obesity management. Med Clin North Am. 2018;102(1):49–63.

    Article  Google Scholar 

  6. Sharma AM, Campbell-Scherer DL. Redefining obesity: beyond the numbers. Obesity (Silver Spring). 2017;25(4):660–1.

    Article  Google Scholar 

  7. Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016;22(Suppl 3):1–203.

    Article  Google Scholar 

  8. Woolcott OO, Bergman RN. Relative fat mass (RFM) as a new estimator of whole-body fat percentage horizontal line. A cross-sectional study in American adult individuals. Sci Rep. 2018;8(1):10980.

    Article  Google Scholar 

  9. Carvalhana SC, Leitao J, Alves AC, et al. Hepatitis B and C prevalence in Portugal: disparity between the general population and high-risk groups. Eur J Gastroenterol Hepatol. 2016;28(6):640–4.

    Article  Google Scholar 

  10. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412–9.

    Article  CAS  Google Scholar 

  11. Marchesini G, Bugianesi E, Forlani G, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology. 2003;37(4):917–23.

    Article  Google Scholar 

  12. Genuth S, Alberti KG, Bennett P, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003;26(11):3160–7.

    Article  Google Scholar 

  13. National High Blood Pressure Education Program Working Group report on primary prevention of hypertension. Arch Intern Med. 1993;153(2):186–208.

  14. Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41(6):1313–21.

    Article  Google Scholar 

  15. Younossi ZM, Stepanova M, Rafiq N, et al. Pathologic criteria for nonalcoholic steatohepatitis: interprotocol agreement and ability to predict liver-related mortality. Hepatology. 2011;53(6):1874–82.

    Article  Google Scholar 

  16. Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45(4):846–54.

    Article  CAS  Google Scholar 

  17. Kabir M, Catalano KJ, Ananthnarayan S, et al. Molecular evidence supporting the portal theory: a causative link between visceral adiposity and hepatic insulin resistance. Am J Physiol Endocrinol Metab. 2005;288(2):E454–61.

    Article  CAS  Google Scholar 

  18. Pang Q, Zhang JY, Song SD, et al. Central obesity and nonalcoholic fatty liver disease risk after adjusting for body mass index. World J Gastroenterol. 2015;21(5):1650–62.

    Article  Google Scholar 

  19. Wu P, Hua Y, Tan S, et al. Interactions of central obesity with rs3918242 on risk of non-alcoholic fat liver disease: a preliminary case-control study. Int J Clin Exp Pathol. 2015;8(4):4165–70.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Wajchenberg BL, Giannella-Neto D, da Silva ME, et al. Depot-specific hormonal characteristics of subcutaneous and visceral adipose tissue and their relation to the metabolic syndrome. Horm Metab Res. 2002;34(11-12):616–21.

    Article  CAS  Google Scholar 

  21. Tison GH, Blaha MJ, Nasir K, et al. Relation of anthropometric obesity and computed tomography measured nonalcoholic fatty liver disease (from the Multiethnic Study of Atherosclerosis). Am J Cardiol. 2015;116(4):541–6.

    Article  Google Scholar 

  22. Ostovaneh MR, Zamani F, Ansari-Moghaddam A, et al. Nonalcoholic fatty liver: the association with metabolic abnormalities, body mass index and central obesity--a population-based study. Metab Syndr Relat Disord. 2015;13(7):304–11.

    Article  CAS  Google Scholar 

  23. Wong RJ, Ahmed A. Obesity and non-alcoholic fatty liver disease: disparate associations among Asian populations. World J Hepatol. 2014;6(5):263–73.

    Article  Google Scholar 

  24. Palmer BF, Clegg DJ. The sexual dimorphism of obesity. Mol Cell Endocrinol. 2015;402:113–9.

    Article  CAS  Google Scholar 

  25. Yang KC, Hung HF, Lu CW, et al. Association of non-alcoholic fatty liver disease with metabolic syndrome independently of central obesity and insulin resistance. Sci Rep. 2016;6:27034.

    Article  CAS  Google Scholar 

  26. Sun K, Kusminski CM, Scherer PE. Adipose tissue remodeling and obesity. J Clin Invest. 2011;121(6):2094–101.

    Article  CAS  Google Scholar 

  27. Kloting N, Bluher M. Adipocyte dysfunction, inflammation and metabolic syndrome. Rev Endocr Metab Disord. 2014;15(4):277–87.

    Article  Google Scholar 

  28. Petaja EM, Sevastianova K, Hakkarainen A, et al. Adipocyte size is associated with NAFLD independent of obesity, fat distribution, and PNPLA3 genotype. Obesity (Silver Spring). 2013;21(6):1174–9.

    Article  Google Scholar 

  29. Wree A, Schlattjan M, Bechmann LP, et al. Adipocyte cell size, free fatty acids and apolipoproteins are associated with non-alcoholic liver injury progression in severely obese patients. Metabolism. 2014;63(12):1542–52.

    Article  CAS  Google Scholar 

  30. du Plessis J, van Pelt J, Korf H, et al. Association of adipose tissue inflammation with histologic severity of nonalcoholic fatty liver disease. Gastroenterology. 2015;149(3):635–48. e14

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal

    Mariana V. Machado, Sara Policarpo, Sofia Carvalhana & Helena Cortez-Pinto

  2. Serviço de Cirurgia, Hospital de Santa Maria, Lisbon, Portugal

    J Coutinho

  3. Unidade de Hepatologia, Serviço de Medicina Interna, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

    Jorge Leitão & Armando Carvalho

  4. Serviço de Gastrenterologia, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal

    Ana P. Silva

  5. Serviço de Gastrenterologia, Centro Hospitalar do Algarve, Faro, Portugal

    Francisco Velasco

  6. Serviço de Gastrenterologia, Hospital Espírito Santo, Évora, Portugal

    Isabel Medeiros

  7. Center of Biodiversity Functional & Integrative Genomics, Instituto Nacional de Saúde Dr. Ricardo Jorge (INSA), Lisbon, Portugal

    Ana Catarina Alves & Mafalda Bourbon

Authors
  1. Mariana V. Machado
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  2. Sara Policarpo
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Correspondence to Mariana V. Machado.

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The authors declare that they have no conflict of interest.

Ethical Approval

The study was approved by the Hospital Santa Maria Human Ethics Committee. The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki, revised in 2000.

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Informed consent was obtained from all individual participants included in the study.

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Machado, M.V., Policarpo, S., Coutinho, J. et al. What Is the Role of the New Index Relative Fat Mass (RFM) in the Assessment of Nonalcoholic Fatty Liver Disease (NAFLD)?. OBES SURG 30, 560–568 (2020). https://doi.org/10.1007/s11695-019-04213-8

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