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Assessment of liver stiffness in subjects affected by familial combined hyperlipidaemia with hepatic steatosis


Prof. Antonino Saitta, Department of Internal Medicine, Via Camiciotti, 82, 98123-Messina, Italy. Tel.: 39-090-2212376; fax: 39-090-2213900; e-mail:


Eur J Clin Invest 2010; 40 (8): 722–728


Background  Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of diseases ranging from simple steatosis to nonalcoholic steatohepatitis (NASH) and is associated with familial combined hyperlipidaemia (FCHL). Currently, the invasive liver biopsy is considered as the gold standard for evaluating liver fibrosis (LF); however, liver stiffness measurement (LSM) by transient elastography (TE) trough FibroScan device may be employed to estimate LF noninvasively. The aim of this study was to evaluate the prevalence of NAFLD in FCHL subjects and to analyse LSM with TE to better identify those individuals with a potential risk of liver disease progression.

Materials and methods  Sixty subjects with FCHL (38 men, 22 women, mean age 46·4 ± 10·9 years) were included in the study. We studied biochemical parameters including lipid profile, glucose, transaminase and insulin; blood pressure and waist circumference (WC) were measured; BMI and HOMA-index were calculated. Ultrasonography was performed to assess liver steatosis and carotid intima-media thickness (IMT). Liver fibrosis was measured by FibroScan.

Results  Patients were classified according to have no (group 0: 19%), mild (group 1: 32%) or moderate–severe (group 2: 49%) steatosis. No difference was found between group 0 and 1 concerning all study parameters. WC (P < 0·05), BMI (P < 0·05), glucose (P < 0·05), insulin (P < 0·001), HOMA-index (P < 0·001) and LSM (6·03 ± 1·9 Kpa vs. 4·2 ± 0·5 Kpa, P < 0·001) were significantly higher in group 2 than groups 1 and 0. Furthermore, LSM correlated with insulin (P < 0·05), glucose (P < 0·05), HOMA-index (P < 0·001), transaminase (P < 0·01) and liver steatosis (P < 0·001). Regression analysis showed that LSM (P < 0·001) and NAFLD (P < 0·01) is associated with HOMA-index; NAFLD is also associated with WC (P < 0·05).

Conclusion  Our results suggest that in FCHL subjects, HOMA-index, an insulin resistance index, is strongly associated with liver steatosis and its progression. Furthermore, in these subjects, we propose the transient elastography to identify and follow up patients for the progression of hepatic disease.