TOTAL CHOLESTEROL / HIGH DENSITY LIPOPROTEIN CHOLESTEROL RATIO, TRIGLYCERIDES / HIGH DENSITY LIPOPROTEIN CHOLESTEROL WITH THE CONTROLLED ATTENUATION PARAMETER (CAP) IN NON-ALCOHOLIC FATTY LIVER

Introduction and Objectives

Non-Alcoholic Fatty Liver Disease (NAFLD) is a global public health problem. The ratio of Total Cholesterol (TC) to High Density Lipoprotein Cholesterol (HDL) and Ultrasensitive C-Reactive Protein have been a biomarker of cardiovascular risk. In a study of the Chinese population, the CT/HDL ratio was established as a predictor of metabolic syndrome and NAFLD >3.8 The optimal cut-off level to predict NAFLD according to the ratio triglycerides (TG)/HDL was established in women >0.9 and in men > 1.4, with sensitivity and specificity of 78 and 77.3% respectively. There are optimal cut-off values of CT/HDL and TG/HDL to predict NAFLD⁴. However, they have not been associated with the degree of hepatic fat infiltration using Transient Elastography (FibroScan®) study by CAP, with a sensitivity of 82% and specificity of 91%. Objective: To describe the relationship CT/HDL, TG/HDL with the controlled attenuation parameter in patients diagnosed with non-alcoholic fatty liver.

Material and Methods

Retrospective study in patients registered in the database of the Gastroenterology outpatient clinic of the Juárez Hospital in Mexico, with a diagnosis of NAFLD, from January 1, 2017 to April 30, 2019, who underwent Fibroscan. The data were obtained from the records of the outpatient clinic and clinical record, it was analyzed in the statistical program Jamovi 1.1.9, to obtain means, medians and percentages. Chi-square test was used for analysis of categorical variables and unidirectional analysis of variance (ANOVA) for continuous variables, establishing a p<0.05 as significant.

Results

In total 48 patients, middle age 49 years (20-76), female 38 (79.2%), with no previous history 29 (60.4%) metabolic syndrome 33 (68.8%) diabetic 19 (39.6%) obesity 27 (56.3%) The CAP for steatosis evaluation: S1, 4 (8.3%) S2, 20 (41.7%) and S3, 24 (50%), for degree of liver fibrosis in Fibroscan: F0, 33 (68.8%) and F1, 14 (29.2%) and by FIB4 scale (<1.30) with NAFLD scale indeterminate fibrosis. The median CT/HDL ratio is not higher with the degree of CAP per FibroScan, being S1, 3.9 (3.1- 4.1) S2, 3.8 (2.3- 6.8) S3, 4.5 (3.1-7.2), (p 0.076). The higher the median TG/HDL ratio, the higher the degree of CAP per FibroScan, being S1, 2.3 (1.6- 2.7) S2, 3.8 (0.9- 7.9) S3, 4.6 (2-16.9) p value 0.008. It was associated that the higher the degree of CAP per Fibroscan, the higher the triglyceride levels above the normal upper value and the greater the association of presenting metabolic syndrome with a p value of 0.009 and 0.003 respectively. (see table)

Discussion

Higher levels of the TG/HDL ratio, elevated triglyceride levels, and the presence of metabolic syndrome increase the degree of CAP in this group of NAFLD patients. This study the largest population was female (79.2%) so it cannot be inferred that the TG/HDL ratio and degree of CAP is relevant for male sex, so more studies should be carried out and these variables determined. This study has as a limitation that it was carried out in a single hospital center so the cohort sample should be increased and carried out prospectively to really determine whether or not it has utility CT/ HDL relationship in NAFLD, since in this study a result was obtained without statistical significance.

Conclusions

The CT/HDL ratio was not associated with the degree of CAP by Fibroscan. It was determined that the higher the median TG/HDL ratio, the higher the degree of CAP in Fibroscan. However, it is necessary to consider this study in patients with high body mass index lowers its sensitivity and specificity, so it should be performed with other advanced imaging modalities.

The authors declare that there is no conflict of interest.