"Normal" liver stiffness measure (LSM) values are higher in both lean and obese individuals: A population-based study from a developing country
The liver stiffness measure (LSM) needs to be explored in ethnically and anthropometrically diverse healthy subjects (to derive an acceptable normal range) and also in patients with liver disease. In view of this objective, LSM was performed by transient elastography (TE) using FibroScan in 437 heal...
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| Published in | Hepatology (Baltimore, Md.) Vol. 55; no. 2; pp. 584 - 593 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Hoboken
Wiley Subscription Services, Inc., A Wiley Company
01.02.2012
Wiley Wolters Kluwer Health, Inc |
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| Abstract | The liver stiffness measure (LSM) needs to be explored in ethnically and anthropometrically diverse healthy subjects (to derive an acceptable normal range) and also in patients with liver disease. In view of this objective, LSM was performed by transient elastography (TE) using FibroScan in 437 healthy subjects with normal alanine aminotransferase (ALT) levels, recruited from a free‐living population of the Birbhum Population Project (BIRPOP; www.shds.in), a Health and Demographic Surveillance System (HDSS), and from 274 patients with liver disease attending the Hepatology Clinic of the School of Digestive and Liver Diseases (SDLD; Institute of Post Graduate Medical Education & Research [IPGME&R], Kolkata, India) including 188 with nonalcoholic fatty liver disease (NAFLD) and 86 with chronic hepatitis of viral and other etiologies. Liver biopsy was performed in 125 patients. The range of normal values for LSM, defined by 5th and 95th percentile values in healthy subjects, was 3.2 and 8.5 kPa, respectively. Healthy subjects with a lower body mass index (BMI; < <18.5 kg/m2) had a higher LSM compared with subjects who had a normal BMI; this LSM value was comparable to that of obese subjects (6.05 ± 1.78 versus 5.51 ± 1.59 and 6.60 ± 1.21, P = 0.016 and 0.349, respectively). Liver disease patients without histologic fibrosis had significantly higher LSM values compared with healthy subjects (7.52 ± 5.49 versus 5.63 ± 1.64, P < 0.001). Among the histologic variables, stage of fibrosis was the only predictor for LSM. LSM did not correlate with inflammatory activity and ALT in both NAFLD and chronic hepatitis groups. Conclusion: LSM varies between 3.2 and 8.5 kPa in healthy subjects of South Asian origin. Both lean and obese healthy subjects have higher LSM values compared with subjects with normal BMI. Liver stiffness begins to increase even before fibrosis appears in patients with liver disease. (Hepatology 2012) |
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| AbstractList | The liver stiffness measure (LSM) needs to be explored in ethnically and anthropometrically diverse healthy subjects (to derive an acceptable normal range) and also in patients with liver disease. In view of this objective, LSM was performed by transient elastography (TE) using FibroScan in 437 healthy subjects with normal alanine aminotransferase (ALT) levels, recruited from a free-living population of the Birbhum Population Project (BIRPOP; www.shds.in), a Health and Demographic Surveillance System (HDSS), and from 274 patients with liver disease attending the Hepatology Clinic of the School of Digestive and Liver Diseases (SDLD; Institute of Post Graduate Medical Education & Research [IPGME&R], Kolkata, India) including 188 with nonalcoholic fatty liver disease (NAFLD) and 86 with chronic hepatitis of viral and other etiologies. Liver biopsy was performed in 125 patients. The range of normal values for LSM, defined by 5th and 95th percentile values in healthy subjects, was 3.2 and 8.5 kPa, respectively. Healthy subjects with a lower body mass index (BMI; < <18.5 kg/m2) had a higher LSM compared with subjects who had a normal BMI; this LSM value was comparable to that of obese subjects (6.05 ± 1.78 versus 5.51 ± 1.59 and 6.60 ± 1.21, P = 0.016 and 0.349, respectively). Liver disease patients without histologic fibrosis had significantly higher LSM values compared with healthy subjects (7.52 ± 5.49 versus 5.63 ± 1.64, P < 0.001). Among the histologic variables, stage of fibrosis was the only predictor for LSM. LSM did not correlate with inflammatory activity and ALT in both NAFLD and chronic hepatitis groups. Conclusion: LSM varies between 3.2 and 8.5 kPa in healthy subjects of South Asian origin. Both lean and obese healthy subjects have higher LSM values compared with subjects with normal BMI. Liver stiffness begins to increase even before fibrosis appears in patients with liver disease. (Hepatology 2012) The liver stiffness measure (LSM) needs to be explored in ethnically and anthropometrically diverse healthy subjects (to derive an acceptable normal range) and also in patients with liver disease. In view of this objective, LSM was performed by transient elastography (TE) using FibroScan in 437 healthy subjects with normal alanine aminotransferase (ALT) levels, recruited from a free-living population of the Birbhum Population Project (BIRPOP; www.shds.in ), a Health and Demographic Surveillance System (HDSS), and from 274 patients with liver disease attending the Hepatology Clinic of the School of Digestive and Liver Diseases (SDLD; Institute of Post Graduate Medical Education & Research [IPGME&R], Kolkata, India) including 188 with nonalcoholic fatty liver disease (NAFLD) and 86 with chronic hepatitis of viral and other etiologies. Liver biopsy was performed in 125 patients. The range of normal values for LSM, defined by 5th and 95th percentile values in healthy subjects, was 3.2 and 8.5 kPa, respectively. Healthy subjects with a lower body mass index (BMI; < <18.5 kg/m super(2)) had a higher LSM compared with subjects who had a normal BMI; this LSM value was comparable to that of obese subjects (6.05 plus or minus 1.78 versus 5.51 plus or minus 1.59 and 6.60 plus or minus 1.21, P = 0.016 and 0.349, respectively). Liver disease patients without histologic fibrosis had significantly higher LSM values compared with healthy subjects (7.52 plus or minus 5.49 versus 5.63 plus or minus 1.64, P < 0.001). Among the histologic variables, stage of fibrosis was the only predictor for LSM. LSM did not correlate with inflammatory activity and ALT in both NAFLD and chronic hepatitis groups. Conclusion: LSM varies between 3.2 and 8.5 kPa in healthy subjects of South Asian origin. Both lean and obese healthy subjects have higher LSM values compared with subjects with normal BMI. Liver stiffness begins to increase even before fibrosis appears in patients with liver disease. (Hepatology 2012) The liver stiffness measure (LSM) needs to be explored in ethnically and anthropometrically diverse healthy subjects (to derive an acceptable normal range) and also in patients with liver disease. In view of this objective, LSM was performed by transient elastography (TE) using FibroScan in 437 healthy subjects with normal alanine aminotransferase (ALT) levels, recruited from a free-living population of the Birbhum Population Project (BIRPOP; www.shds.in), a Health and Demographic Surveillance System (HDSS), and from 274 patients with liver disease attending the Hepatology Clinic of the School of Digestive and Liver Diseases (SDLD; Institute of Post Graduate Medical Education & Research [IPGME&R], Kolkata, India) including 188 with nonalcoholic fatty liver disease (NAFLD) and 86 with chronic hepatitis of viral and other etiologies. Liver biopsy was performed in 125 patients. The range of normal values for LSM, defined by 5th and 95th percentile values in healthy subjects, was 3.2 and 8.5 kPa, respectively. Healthy subjects with a lower body mass index (BMI; < <18.5 kg/m(2)) had a higher LSM compared with subjects who had a normal BMI; this LSM value was comparable to that of obese subjects (6.05 ± 1.78 versus 5.51 ± 1.59 and 6.60 ± 1.21, P = 0.016 and 0.349, respectively). Liver disease patients without histologic fibrosis had significantly higher LSM values compared with healthy subjects (7.52 ± 5.49 versus 5.63 ± 1.64, P < 0.001). Among the histologic variables, stage of fibrosis was the only predictor for LSM. LSM did not correlate with inflammatory activity and ALT in both NAFLD and chronic hepatitis groups. LSM varies between 3.2 and 8.5 kPa in healthy subjects of South Asian origin. Both lean and obese healthy subjects have higher LSM values compared with subjects with normal BMI. Liver stiffness begins to increase even before fibrosis appears in patients with liver disease. The liver stiffness measure (LSM) needs to be explored in ethnically and anthropometrically diverse healthy subjects (to derive an acceptable normal range) and also in patients with liver disease. In view of this objective, LSM was performed by transient elastography (TE) using FibroScan in 437 healthy subjects with normal alanine aminotransferase (ALT) levels, recruited from a free-living population of the Birbhum Population Project (BIRPOP; www.shds.in), a Health and Demographic Surveillance System (HDSS), and from 274 patients with liver disease attending the Hepatology Clinic of the School of Digestive and Liver Diseases (SDLD; Institute of Post Graduate Medical Education & Research [IPGME&R], Kolkata, India) including 188 with nonalcoholic fatty liver disease (NAFLD) and 86 with chronic hepatitis of viral and other etiologies. Liver biopsy was performed in 125 patients. The range of normal values for LSM, defined by 5th and 95th percentile values in healthy subjects, was 3.2 and 8.5 kPa, respectively. Healthy subjects with a lower body mass index (BMI; < <18.5 kg/m(2)) had a higher LSM compared with subjects who had a normal BMI; this LSM value was comparable to that of obese subjects (6.05 ± 1.78 versus 5.51 ± 1.59 and 6.60 ± 1.21, P = 0.016 and 0.349, respectively). Liver disease patients without histologic fibrosis had significantly higher LSM values compared with healthy subjects (7.52 ± 5.49 versus 5.63 ± 1.64, P < 0.001). Among the histologic variables, stage of fibrosis was the only predictor for LSM. LSM did not correlate with inflammatory activity and ALT in both NAFLD and chronic hepatitis groups.UNLABELLEDThe liver stiffness measure (LSM) needs to be explored in ethnically and anthropometrically diverse healthy subjects (to derive an acceptable normal range) and also in patients with liver disease. In view of this objective, LSM was performed by transient elastography (TE) using FibroScan in 437 healthy subjects with normal alanine aminotransferase (ALT) levels, recruited from a free-living population of the Birbhum Population Project (BIRPOP; www.shds.in), a Health and Demographic Surveillance System (HDSS), and from 274 patients with liver disease attending the Hepatology Clinic of the School of Digestive and Liver Diseases (SDLD; Institute of Post Graduate Medical Education & Research [IPGME&R], Kolkata, India) including 188 with nonalcoholic fatty liver disease (NAFLD) and 86 with chronic hepatitis of viral and other etiologies. Liver biopsy was performed in 125 patients. The range of normal values for LSM, defined by 5th and 95th percentile values in healthy subjects, was 3.2 and 8.5 kPa, respectively. Healthy subjects with a lower body mass index (BMI; < <18.5 kg/m(2)) had a higher LSM compared with subjects who had a normal BMI; this LSM value was comparable to that of obese subjects (6.05 ± 1.78 versus 5.51 ± 1.59 and 6.60 ± 1.21, P = 0.016 and 0.349, respectively). Liver disease patients without histologic fibrosis had significantly higher LSM values compared with healthy subjects (7.52 ± 5.49 versus 5.63 ± 1.64, P < 0.001). Among the histologic variables, stage of fibrosis was the only predictor for LSM. LSM did not correlate with inflammatory activity and ALT in both NAFLD and chronic hepatitis groups.LSM varies between 3.2 and 8.5 kPa in healthy subjects of South Asian origin. Both lean and obese healthy subjects have higher LSM values compared with subjects with normal BMI. Liver stiffness begins to increase even before fibrosis appears in patients with liver disease.CONCLUSIONLSM varies between 3.2 and 8.5 kPa in healthy subjects of South Asian origin. Both lean and obese healthy subjects have higher LSM values compared with subjects with normal BMI. Liver stiffness begins to increase even before fibrosis appears in patients with liver disease. |
| Author | Mukherjee, Partha S. Das, Kausik Das, Kshaunish Santra, Amal Chowdhury, Abhijit Ahmed, Sk. Mahiuddin Mridha, Asit R. Dhali, Gopal K. Sarkar, Rajib |
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| References | Castera L, Forns X, Alberti A. Non-invasive evaluation of liver fibrosis by transient elastography. J Hepatol 2008; 48: 835-847. Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology 2007; 45: 507-539. Rockey DC, Housset CN, Friedman SL. Activation-dependent contractility of rat hepatic lipocytes in culture and in vivo. J Clin Invest 1993; 92: 1795-1804. Bedossa P, Poynard T; The French METAVIR Cooperative Study Group. An algorithm for grading activity in chronic hepatitis C. HEPATOLOGY 1996; 24: 289-293. Green R, Flamm S. AGA technical review on the evaluation of liver chemistry tests. Gastroenterology 2002; 123: 1367-1384. Millonig G, Reimann FM, Friedrich S, Fonouni H, Mehrabi A, Buchler MW, et al. Extrahepatic cholestasis increases liver stiffness (FibroScan) regardless of fibrosis. HEPATOLOGY 2008; 48: 1718-1723. Chowdhury A, Santra A, Chaudhuri S, Dhali GK, Chaudhuri S, Maity SG, et al. Hepatitis C virus infection in the general population: a community-based study in West Bengal, India. HEPATOLOGY 2003; 37: 802-809. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet 2008; 371: 838-851. Williams R. Global challenges in liver disease. Hepatology 2006; 44: 521-526. Jacqueminet S, Lebray P, Morra R, Munteanu M, Devers L, Messous D, et al. Screening for liver fibrosis by using a noninvasive biomarker in patients with diabetes. Clin Gastroenterol Hepatol 2008; 6: 828-831. Roulot D, Czernichow S, Le Clésiau H, Costes JL, Vergnaud AC, Beaugrand M. Liver stiffness values in apparently healthy subjects: influence of gender and metabolic syndrome. J Hepatol 2008; 48: 606-613. Farrell GC, Chitturi S, Lau GKK, Sollano JD, for the Asia-Pacific Working Party on NAFLD. Guidelines for the assessment and management of non-alcoholic fatty liver disease in the Asia-Pacific region: executive summary. J Gastroenterol Hepatol 2007; 22: 775-777. Roan E. The effect of Glisson's capsule on the superficial elasticity measurements of the liver. J Biomech Eng 2010; 132: 104-105. Yajima Y, Ohta K, Narui T, Abe R, Suzuki H, Ohtsuki M. Ultrasonographical diagnosis of fatty liver: significance of the liver-kidney contrast. Tohoku J Exp Med 1983; 139: 43-50. Poynard T, Lebray P, Ingiliz P, Varaut A, Varsat B, Ngo Y, et al. Prevalence of liver fibrosis and risk factors in a general population using non-invasive biomarkers (FibroTest). BMC Gastroenterol 2010; 10: 40. Bedossa P, Dargère D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. HEPATOLOGY 2003; 38: 1449-1457. Das K, Das K, Mukherjee PS, Ghosh A, Ghosh S, Mridha AR, et al. Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease. HEPATOLOGY 2010; 51: 1593-1602. Roulot D, Costes JL, Buyck JF, Warzocha U, Gambier N, Czernichow S, et al. Transient elastography as a screening tool for liver fibrosis and cirrhosis in a community-based population aged over 45 years. Gut 2011; 60: 977-984. Poynard T, Ngo Y, Munteanu M, Thabut D, Massard J, Moussalli J, et al. Biomarkers of liver injury for hepatitis clinical trials: a meta-analysis of longitudinal studies. Antivir Ther 2010; 15: 617-631. Orescanin M, Qayyum MA, Toohey KS, Insana MF. Dispersion and shear modulus measurements of porcine liver. Ultrason Imaging 2010; 32: 255-266. Yoneda M, Fujita K, Inamori M, Nakajima A, Tamano M, Hiraishi H. Transient elastography in patients with non-alcoholic fatty liver disease (NAFLD). Gut 2007; 56: 1330-1331. Food and Agriculture Organization of the United Nations. The double burden of malnutrition: case studies from six developing countries. FAO Food Nutr Pap 2006; 84: 1-334. WHO expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363: 157-163. Sagir A, Erhardt A, Schmitt M, Haussinger D. Transient elastography is unreliable for detection of cirrhosis in patients with acute liver damage. Hepatology 2008; 47: 592-595. Gaia S, Carenzi S, Barilli AL, Bugianesi E, Smedile A, Brunello F et al. Reliability of transient elastography for the detection of fibrosis in non-alcoholic fatty liver disease and chronic viral hepatitis. J Hepatol 2011; 54: 64-71. Tsochatzis EA, Gurusamy KS, Ntaoula S, Cholongitas E, Davidson BR, Burroughs AK. Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta-analysis of diagnostic accuracy. J Hepatol 2011; 54: 650-659. Sirli R, Sporea I, Tudora A, Deleanu A, Popescu A. Transient elastographic evaluation of subjects without known hepatic pathology: does age change the liver stiffness? J Gastrointest Liver Dis 2009; 18: 57-60. Corpechot C, El Naggar A, Poupon R. Gender and liver: is the liver stiffness weaker in weaker sex? HEPATOLOGY 2006; 44: 513-514. Castéra L, Foucher J, Bernard PH, Carvalho F, Allaix D, Merrouche W, et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. HEPATOLOGY 2010; 51: 828-835. Ghany MG, Strader DB, Thomas DL, Seef LB. AASLD Practice Guidelines. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology 2009; 49: 1335-1374. Vergniol J, Foucher J, Terrebonne E, Bernard PH, Bail BL, Merrouche W, et al. Noninvasive tests for fibrosis and liver stiffness predict 5-year outcomes of patients with chronic hepatitis C. Gastroenterology 2011; 140: 1970-1979. Kleiner DE, Brunt EM, Natta MV, Behling C, Contos MJ, Cummings OW, et al. for the Nonalcoholic Steatohepatitis Clinical Research Network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. HEPATOLOGY 2005; 41: 1313-1321. Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, et al. International Autoimmune Hepatitis Group report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol 1999; 31: 929-938. Rockey DC, Boyles JK, Gabbiani G, Friedman SL. Rat hepatic lipocytes express smooth muscle actin upon activation in vivo and in culture. J Submicrosc Cytol Pathol 1992; 24: 193-203. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and B-cell function from fasting glucose and insulin concentrations in man. Diabetologia 1985; 28: 412-419. Quigley MA. Shifting burden of disease-epidemiological transition in India. Int J Epidemiol 2006; 35: 1530-1531. Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology 2008; 134: 960-974. Poynard T, Ingiliz P, Elkrief L, Munteanu M, Lebray P, Morra R, et al. Concordance in a world without a gold standard: a new non-invasive methodology for improving accuracy of fibrosis markers. PLoS One 2008; 3: e3857. Georges PC, Hui JJ, Gombos Z, McCormick ME, Wang AY, Uemura M, et al. Increased stiffness of the rat liver precedes matrix deposition: implications for fibrosis. Am J Physiol Gastrointest Liver Physiol 2007; 293: G1147-G1154. Millonig G, Friedrich S, Adolf S, Fonouni H, Golriz M, Mehrabi A, et al. Liver stiffness is directly influenced by central venous pressure. J Hepatol 2010; 52: 206-210. Menghini G. One-second needle biopsy of the liver. Gastroenterology 1958; 35: 190-199. Poynard T, Benhamou Y, Thabut D, Ratziu V. Liver biopsy: the best standard when everything else fails. J Hepatol 2009; 50: 1267-1268. Kumar M, Sarin SK, Hissar S, Pande C, Sakhuja P, Sharma BC, et al. Virologic and histologic features of chronic hepatitis B virus-infected asymptomatic patients with persistently normal ALT. Gastroenterology 2008; 134: 1376-1384. Chowdhury A, Santra A, Chakravorty R, Banerji A, Pal S, Dhali GK, et al. Community-based epidemiology of hepatitis B virus infection in West Bengal, India: prevalence of hepatitis B e antigen-negative infection and associated viral variants. J Gastroenterol Hepatol 2005; 20: 1712-1720. Alberti KGMM, Zimmet P, Shaw J, for the IDF Epidemiology Task Force Consensus Group. The metabolic syndrome-a new worldwide definition. Lancet 2005; 366: 1059-1062. Vizzutti F, Arena U, Romanelli RG, Rega L, Foschi M, Colagrande S, et al. Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis. Hepatology 2007; 45: 1290-1297. Misra A, Khurana L. Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab 2008; 93: S9-S30. 1983; 139 2004; 363 1985; 28 2010; 32 2010; 10 2010; 15 2006; 35 2011; 60 1958; 35 2005; 41 2003; 37 2005; 20 2011; 54 2003; 38 2008; 6 2008; 3 2008; 93 2007; 56 2009; 49 2006; 84 2007; 293 2009; 50 2006; 44 2005; 366 1993; 92 2002; 123 2010; 132 2008; 47 2008; 48 1999; 31 1992; 24 2008; 134 2011; 140 1996; 24 2007; 22 2007; 45 2010; 52 2010; 51 2008; 371 2009; 18 Lok (R23-27-20241201) 2007; 45 Roulot (R10-27-20241201) 2008; 48 Castera (R7-27-20241201) 2010; 51 Rockey (R47-27-20241201) 1993; 92 Farrell (R21-27-20241201) 2007; 22 Vergniol (R2-27-20241201) 2011; 140 Kleiner (R26-27-20241201) 2005; 41 Millonig (R36-27-20241201) 2008; 48 Alvarez (R24-27-20241201) 1999; 31 Misra (R14-27-20241201) 2008; 93 Poynard (R8-27-20241201) 2008; 3 Bedossa (R4-27-20241201) 1996; 24 Roulot (R6-27-20241201) 2011; 60 Orescanin (R32-27-20241201) 2010; 32 (R30-27-20241201) 2006; 84 Schuppan (R20-27-20241201) 2008; 371 (R13-27-20241201) 2004; 363 Rockey (R46-27-20241201) 1992; 24 Sirli (R31-27-20241201) 2009; 18 Vizzutti (R34-27-20241201) 2007; 45 Chowdhury (R15-27-20241201) 2003; 37 Ghany (R22-27-20241201) 2009; 49 Millonig (R35-27-20241201) 2010; 52 Bedossa (R44-27-20241201) 2003; 38 Georges (R9-27-20241201) 2007; 293 Chowdhury (R16-27-20241201) 2005; 20 Das (R12-27-20241201) 2010; 51 Sagir (R37-27-20241201) 2008; 47 Corpechot (R11-27-20241201) 2006; 44 Williams (R28-27-20241201) 2006; 44 Quigley (R29-27-20241201) 2006; 35 Yoneda (R38-27-20241201) 2007; 56 Matthews (R19-27-20241201) 1985; 28 Gaia (R39-27-20241201) 2011; 54 FriedrichRust (R5-27-20241201) 2008; 134 Castera (R1-27-20241201) 2008; 48 Menghini (R25-27-20241201) 1958; 35 Poynard (R41-27-20241201) 2010; 10 Poynard (R42-27-20241201) 2010; 15 Roan (R33-27-20241201) 2010; 132 Kumar (R3-27-20241201) 2008; 134 Yajima (R17-27-20241201) 1983; 139 Jacqueminet (R40-27-20241201) 2008; 6 Tsochatzis (R43-27-20241201) 2011; 54 Alberti (R18-27-20241201) 2005; 366 Green (R27-27-20241201) 2002; 123 Poynard (R45-27-20241201) 2009; 50 22419516 - Hepatology. 2012 Sep;56(3):1183-4; author reply 1184-5 |
| References_xml | – reference: Ghany MG, Strader DB, Thomas DL, Seef LB. AASLD Practice Guidelines. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology 2009; 49: 1335-1374. – reference: Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, et al. International Autoimmune Hepatitis Group report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol 1999; 31: 929-938. – reference: Chowdhury A, Santra A, Chaudhuri S, Dhali GK, Chaudhuri S, Maity SG, et al. Hepatitis C virus infection in the general population: a community-based study in West Bengal, India. HEPATOLOGY 2003; 37: 802-809. – reference: Corpechot C, El Naggar A, Poupon R. Gender and liver: is the liver stiffness weaker in weaker sex? HEPATOLOGY 2006; 44: 513-514. – reference: Green R, Flamm S. AGA technical review on the evaluation of liver chemistry tests. Gastroenterology 2002; 123: 1367-1384. – reference: Millonig G, Reimann FM, Friedrich S, Fonouni H, Mehrabi A, Buchler MW, et al. Extrahepatic cholestasis increases liver stiffness (FibroScan) regardless of fibrosis. HEPATOLOGY 2008; 48: 1718-1723. – reference: Roulot D, Czernichow S, Le Clésiau H, Costes JL, Vergnaud AC, Beaugrand M. Liver stiffness values in apparently healthy subjects: influence of gender and metabolic syndrome. J Hepatol 2008; 48: 606-613. – reference: Alberti KGMM, Zimmet P, Shaw J, for the IDF Epidemiology Task Force Consensus Group. The metabolic syndrome-a new worldwide definition. Lancet 2005; 366: 1059-1062. – reference: Food and Agriculture Organization of the United Nations. The double burden of malnutrition: case studies from six developing countries. FAO Food Nutr Pap 2006; 84: 1-334. – reference: Sagir A, Erhardt A, Schmitt M, Haussinger D. Transient elastography is unreliable for detection of cirrhosis in patients with acute liver damage. Hepatology 2008; 47: 592-595. – reference: Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology 2008; 134: 960-974. – reference: Vizzutti F, Arena U, Romanelli RG, Rega L, Foschi M, Colagrande S, et al. Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis. Hepatology 2007; 45: 1290-1297. – reference: Williams R. Global challenges in liver disease. Hepatology 2006; 44: 521-526. – reference: Schuppan D, Afdhal NH. Liver cirrhosis. Lancet 2008; 371: 838-851. – reference: Bedossa P, Poynard T; The French METAVIR Cooperative Study Group. An algorithm for grading activity in chronic hepatitis C. HEPATOLOGY 1996; 24: 289-293. – reference: Poynard T, Benhamou Y, Thabut D, Ratziu V. Liver biopsy: the best standard when everything else fails. J Hepatol 2009; 50: 1267-1268. – reference: Tsochatzis EA, Gurusamy KS, Ntaoula S, Cholongitas E, Davidson BR, Burroughs AK. Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta-analysis of diagnostic accuracy. J Hepatol 2011; 54: 650-659. – reference: Poynard T, Ingiliz P, Elkrief L, Munteanu M, Lebray P, Morra R, et al. Concordance in a world without a gold standard: a new non-invasive methodology for improving accuracy of fibrosis markers. PLoS One 2008; 3: e3857. – reference: Menghini G. One-second needle biopsy of the liver. Gastroenterology 1958; 35: 190-199. – reference: WHO expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363: 157-163. – reference: Orescanin M, Qayyum MA, Toohey KS, Insana MF. Dispersion and shear modulus measurements of porcine liver. Ultrason Imaging 2010; 32: 255-266. – reference: Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology 2007; 45: 507-539. – reference: Gaia S, Carenzi S, Barilli AL, Bugianesi E, Smedile A, Brunello F et al. Reliability of transient elastography for the detection of fibrosis in non-alcoholic fatty liver disease and chronic viral hepatitis. J Hepatol 2011; 54: 64-71. – reference: Roulot D, Costes JL, Buyck JF, Warzocha U, Gambier N, Czernichow S, et al. Transient elastography as a screening tool for liver fibrosis and cirrhosis in a community-based population aged over 45 years. Gut 2011; 60: 977-984. – reference: Das K, Das K, Mukherjee PS, Ghosh A, Ghosh S, Mridha AR, et al. Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease. HEPATOLOGY 2010; 51: 1593-1602. – reference: Rockey DC, Housset CN, Friedman SL. Activation-dependent contractility of rat hepatic lipocytes in culture and in vivo. J Clin Invest 1993; 92: 1795-1804. – reference: Vergniol J, Foucher J, Terrebonne E, Bernard PH, Bail BL, Merrouche W, et al. Noninvasive tests for fibrosis and liver stiffness predict 5-year outcomes of patients with chronic hepatitis C. Gastroenterology 2011; 140: 1970-1979. – reference: Misra A, Khurana L. Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab 2008; 93: S9-S30. – reference: Bedossa P, Dargère D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. HEPATOLOGY 2003; 38: 1449-1457. – reference: Roan E. The effect of Glisson's capsule on the superficial elasticity measurements of the liver. J Biomech Eng 2010; 132: 104-105. – reference: Yoneda M, Fujita K, Inamori M, Nakajima A, Tamano M, Hiraishi H. Transient elastography in patients with non-alcoholic fatty liver disease (NAFLD). Gut 2007; 56: 1330-1331. – reference: Castéra L, Foucher J, Bernard PH, Carvalho F, Allaix D, Merrouche W, et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. HEPATOLOGY 2010; 51: 828-835. – reference: Castera L, Forns X, Alberti A. Non-invasive evaluation of liver fibrosis by transient elastography. J Hepatol 2008; 48: 835-847. – reference: Kumar M, Sarin SK, Hissar S, Pande C, Sakhuja P, Sharma BC, et al. Virologic and histologic features of chronic hepatitis B virus-infected asymptomatic patients with persistently normal ALT. Gastroenterology 2008; 134: 1376-1384. – reference: Quigley MA. Shifting burden of disease-epidemiological transition in India. Int J Epidemiol 2006; 35: 1530-1531. – reference: Yajima Y, Ohta K, Narui T, Abe R, Suzuki H, Ohtsuki M. Ultrasonographical diagnosis of fatty liver: significance of the liver-kidney contrast. Tohoku J Exp Med 1983; 139: 43-50. – reference: Millonig G, Friedrich S, Adolf S, Fonouni H, Golriz M, Mehrabi A, et al. Liver stiffness is directly influenced by central venous pressure. J Hepatol 2010; 52: 206-210. – reference: Farrell GC, Chitturi S, Lau GKK, Sollano JD, for the Asia-Pacific Working Party on NAFLD. Guidelines for the assessment and management of non-alcoholic fatty liver disease in the Asia-Pacific region: executive summary. J Gastroenterol Hepatol 2007; 22: 775-777. – reference: Rockey DC, Boyles JK, Gabbiani G, Friedman SL. Rat hepatic lipocytes express smooth muscle actin upon activation in vivo and in culture. J Submicrosc Cytol Pathol 1992; 24: 193-203. – reference: Poynard T, Ngo Y, Munteanu M, Thabut D, Massard J, Moussalli J, et al. Biomarkers of liver injury for hepatitis clinical trials: a meta-analysis of longitudinal studies. Antivir Ther 2010; 15: 617-631. – reference: Georges PC, Hui JJ, Gombos Z, McCormick ME, Wang AY, Uemura M, et al. Increased stiffness of the rat liver precedes matrix deposition: implications for fibrosis. Am J Physiol Gastrointest Liver Physiol 2007; 293: G1147-G1154. – reference: Sirli R, Sporea I, Tudora A, Deleanu A, Popescu A. Transient elastographic evaluation of subjects without known hepatic pathology: does age change the liver stiffness? J Gastrointest Liver Dis 2009; 18: 57-60. – reference: Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and B-cell function from fasting glucose and insulin concentrations in man. Diabetologia 1985; 28: 412-419. – reference: Poynard T, Lebray P, Ingiliz P, Varaut A, Varsat B, Ngo Y, et al. Prevalence of liver fibrosis and risk factors in a general population using non-invasive biomarkers (FibroTest). BMC Gastroenterol 2010; 10: 40. – reference: Chowdhury A, Santra A, Chakravorty R, Banerji A, Pal S, Dhali GK, et al. Community-based epidemiology of hepatitis B virus infection in West Bengal, India: prevalence of hepatitis B e antigen-negative infection and associated viral variants. J Gastroenterol Hepatol 2005; 20: 1712-1720. – reference: Kleiner DE, Brunt EM, Natta MV, Behling C, Contos MJ, Cummings OW, et al. for the Nonalcoholic Steatohepatitis Clinical Research Network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. HEPATOLOGY 2005; 41: 1313-1321. – reference: Jacqueminet S, Lebray P, Morra R, Munteanu M, Devers L, Messous D, et al. Screening for liver fibrosis by using a noninvasive biomarker in patients with diabetes. Clin Gastroenterol Hepatol 2008; 6: 828-831. – volume: 366 start-page: 1059 year: 2005 end-page: 1062 article-title: The metabolic syndrome—a new worldwide definition publication-title: Lancet – volume: 44 start-page: 513 year: 2006 end-page: 514 article-title: Gender and liver: is the liver stiffness weaker in weaker sex? publication-title: HEPATOLOGY – volume: 49 start-page: 1335 year: 2009 end-page: 1374 article-title: AASLD Practice Guidelines. Diagnosis, management, and treatment of hepatitis C: an update publication-title: Hepatology – volume: 45 start-page: 507 year: 2007 end-page: 539 article-title: Chronic hepatitis B publication-title: Hepatology – volume: 371 start-page: 838 year: 2008 end-page: 851 article-title: Liver cirrhosis publication-title: Lancet – volume: 51 start-page: 1593 year: 2010 end-page: 1602 article-title: Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease publication-title: HEPATOLOGY – volume: 123 start-page: 1367 year: 2002 end-page: 1384 article-title: AGA technical review on the evaluation of liver chemistry tests publication-title: Gastroenterology – volume: 44 start-page: 521 year: 2006 end-page: 526 article-title: Global challenges in liver disease publication-title: Hepatology – volume: 84 start-page: 1 year: 2006 end-page: 334 article-title: The double burden of malnutrition: case studies from six developing countries publication-title: FAO Food Nutr Pap – volume: 51 start-page: 828 year: 2010 end-page: 835 article-title: Pitfalls of liver stiffness measurement: a 5‐year prospective study of 13,369 examinations publication-title: HEPATOLOGY – volume: 93 start-page: S9 year: 2008 end-page: S30 article-title: Obesity and the metabolic syndrome in developing countries publication-title: J Clin Endocrinol Metab – volume: 24 start-page: 193 year: 1992 end-page: 203 article-title: Rat hepatic lipocytes express smooth muscle actin upon activation in vivo and in culture publication-title: J Submicrosc Cytol Pathol – volume: 48 start-page: 835 year: 2008 end-page: 847 article-title: Non‐invasive evaluation of liver fibrosis by transient elastography publication-title: J Hepatol – volume: 35 start-page: 190 year: 1958 end-page: 199 article-title: One‐second needle biopsy of the liver publication-title: Gastroenterology – volume: 45 start-page: 1290 year: 2007 end-page: 1297 article-title: Liver stiffness measurement predicts severe portal hypertension in patients with HCV‐related cirrhosis publication-title: Hepatology – volume: 47 start-page: 592 year: 2008 end-page: 595 article-title: Transient elastography is unreliable for detection of cirrhosis in patients with acute liver damage publication-title: Hepatology – volume: 54 start-page: 650 year: 2011 end-page: 659 article-title: Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta‐analysis of diagnostic accuracy publication-title: J Hepatol – volume: 41 start-page: 1313 year: 2005 end-page: 1321 article-title: for the Nonalcoholic Steatohepatitis Clinical Research Network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease publication-title: HEPATOLOGY – volume: 48 start-page: 1718 year: 2008 end-page: 1723 article-title: Extrahepatic cholestasis increases liver stiffness (FibroScan) regardless of fibrosis publication-title: HEPATOLOGY – volume: 37 start-page: 802 year: 2003 end-page: 809 article-title: Hepatitis C virus infection in the general population: a community‐based study in West Bengal, India publication-title: HEPATOLOGY – volume: 28 start-page: 412 year: 1985 end-page: 419 article-title: Homeostasis model assessment: insulin resistance and B‐cell function from fasting glucose and insulin concentrations in man publication-title: Diabetologia – volume: 54 start-page: 64 year: 2011 end-page: 71 article-title: Reliability of transient elastography for the detection of fibrosis in non‐alcoholic fatty liver disease and chronic viral hepatitis publication-title: J Hepatol – volume: 38 start-page: 1449 year: 2003 end-page: 1457 article-title: Sampling variability of liver fibrosis in chronic hepatitis C publication-title: HEPATOLOGY – volume: 35 start-page: 1530 year: 2006 end-page: 1531 article-title: Shifting burden of disease—epidemiological transition in India publication-title: Int J Epidemiol – volume: 31 start-page: 929 year: 1999 end-page: 938 article-title: International Autoimmune Hepatitis Group report: review of criteria for diagnosis of autoimmune hepatitis publication-title: J Hepatol – volume: 50 start-page: 1267 year: 2009 end-page: 1268 article-title: Liver biopsy: the best standard when everything else fails publication-title: J Hepatol – volume: 32 start-page: 255 year: 2010 end-page: 266 article-title: Dispersion and shear modulus measurements of porcine liver publication-title: Ultrason Imaging – volume: 139 start-page: 43 year: 1983 end-page: 50 article-title: Ultrasonographical diagnosis of fatty liver: significance of the liver‐kidney contrast publication-title: Tohoku J Exp Med – volume: 52 start-page: 206 year: 2010 end-page: 210 article-title: Liver stiffness is directly influenced by central venous pressure publication-title: J Hepatol – volume: 140 start-page: 1970 year: 2011 end-page: 1979 article-title: Noninvasive tests for fibrosis and liver stiffness predict 5‐year outcomes of patients with chronic hepatitis C publication-title: Gastroenterology – volume: 56 start-page: 1330 year: 2007 end-page: 1331 article-title: Transient elastography in patients with non‐alcoholic fatty liver disease (NAFLD) publication-title: Gut – volume: 6 start-page: 828 year: 2008 end-page: 831 article-title: Screening for liver fibrosis by using a noninvasive biomarker in patients with diabetes publication-title: Clin Gastroenterol Hepatol – volume: 132 start-page: 104 year: 2010 end-page: 105 article-title: The effect of Glisson's capsule on the superficial elasticity measurements of the liver publication-title: J Biomech Eng – volume: 60 start-page: 977 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| Title | "Normal" liver stiffness measure (LSM) values are higher in both lean and obese individuals: A population-based study from a developing country |
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