Background and aims: Despite the increasing use of noninvasive methods for the assessment of liver fibrosis and steatosis, the effect of fasting and food intake on these parameters is not yet clear. Our aims were to evaluate the effect of food intake on liver stiffness (LS) (measured by transient elastography) and controlled attenuation parameter (CAP) in patients with different degrees of liver disease and healthy volunteers, and secondarily, to assess possible factors associated with variations of LS and CAP.
Methods: We performed a prospective single-center study including patients with liver disease and healthy volunteers. LS and CAP were evaluated using FibroScan® (Echosens, Paris, France), before (fasting ≥8 h) and 30 min after intake of a standardized breakfast. We used common cutoffs for LS: > 7 kPa for significant fibrosis (F2 to F4) and > 11 to 14 kPa (mean 12.5 kPa) for cirrhosis.
Results: Fifty-nine (72%) patients with liver disease and 22 (28%) healthy volunteers were included. LS significantly increased 30 min after food intake (pre-meal 6.1 kPa [IQR: 4.7-9.8] vs. after-meal 6.8 kPa [IQR: 5.5-10.6]; p < 0.001). This difference was only significant in patients with chronic liver disease (p = 0.02) and not in healthy volunteers (p = 0.106). CAP values did not increase significantly after food intake. Gender, body mass index, mass of body fat, lean body mass, and percent of body fat were not related with significant variations of LS and CAP values after meal intake.
Conclusions: Significant variations of LS were observed after ingestion of a standard meal, which may have consequences for patient management. CAP values were not significantly affected by food intake. Therefore, we consider that before the isolated evaluation of CAP, it is not necessary to perform any fasting period.
Introdução e objetivos: Apesar do uso crescente de metodos nao invasivos para a avaliacao da fibrose hepatica e da esteatose, ainda nao esta claro o efeito do jejum e da ingestao alimentar na determinacao destes parametros. Os nossos objetivos foram avaliar o efeito da ingestao de alimentos sobre a rigidez hepatica (LS) (medida por elastografia transitoria) e o parametro de atenuacao controlada (CAP) em doentes com diferentes graus de doenca hepatica e voluntarios saudaveis e, secundariamente, avaliar possiveis fatores associados as variacoes de LS e CAP.
Metodos: Realizamos um estudo prospetivo, num unico centro, incluindo doentes com doenca hepatica cronica e voluntarios saudaveis. A LS e o CAP foram determinados com a utilizacao de FibroScanR, antes (jejum .8 h) e 30 minutos apos a ingestao de um pequeno-almoco padronizado. Foram usados pontos de corte comuns para a elastografia: > 7 kPa para fibrose significativa (F2 a F4) e > 11.14 kPa (media 12.5 kPa) para cirrose.
Resultados: Cinquenta e nove (72%) doentes com doenca hepatica cronica e 22 (28%) voluntarios saudaveis foram incluidos. A LS aumentou significativamente 30 minutos apos a ingestao de alimentos (pre-refeicao 6.1 kPa [IQR: 4.7.9.8] versus apos a refeicao 6.8 kPa [IQR: 5.5.10.6], p < 0.001). Essa diferenca foi significativa em doentes com doenca hepatica cronica (p = 0.02) mas nao nos voluntarios saudaveis (p = 0.106). Os valores da CAP nao variaram significativamente apos a ingestao de alimentos. O genero, o IMC, a massa de gordura corporal, a massa corporal magra e a percentagem de gordura corporal nao se associaram a variacoes significativas dos valores de LS e CAP apos a ingestao da refeicao.
Conclusoes: Verificaram-se variacoes significativas da LS apos a ingestao de uma refeicao padrao, o que pode ter consequencias na avaliacao dos doentes. Os valores da CAP nao foram significativamente afetados pela ingestao de alimentos. Por isso, consideramos que perante a avaliacao isolada de CAP nao e necessario a realizacao de qualquer periodo de jejum.
Keywords: Fibroscan; Healthy volunteers; Liver disease.