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Correlation between Non-Alcoholic Fatty Liver Disease (NAFLD) fibrosis score (NFS) with Left Ventricular Mass Index (LVMI) in patients with NAFLD

Faculty of Medicine, Universitas Diponegoro, Indonesia

Received: 1 Jul 2021; Revised: 22 Aug 2021; Accepted: 29 Aug 2021; Available online: 31 Aug 2021; Published: 31 Aug 2021.
Open Access Copyright (c) 2021 Journal of Biomedicine and Translational Research
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

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Background: Cardiovascular-related mortality is a major concern in NAFLD. Advanced fibrosis was known to be associated with cardiovascular diseases. NAFLD Fibrosis Score (NFS) is used to identify the development of liver fibrosis in NAFLD patients. Left ventricular mass index (LVMI) is a sign of subclinical cardiovascular complications in NAFLD. The correlation between NAFLD fibrosis score with LVMI in NAFLD patients is not fully established.

Objective: To analyze the correlation between NAFLD fibrosis score with LVMI  in NAFLD patients.

Methods: A cross-sectional study of NAFLD patients in Kariadi Hospital Indonesia. NFS was done using a formula based on clinical and biochemical parameters. LVMI was measured with echocardiography. Pearson’s, Mann-Whitney, and logistic regression were used for analysis.

Results: A total of 64 patients with primary NAFLD were enrolled, 54.7% males and 45.3% females. Mean age was 52,8 ± 10,5 years (30-77 years). Based on NFS criteria, high probability group was the highest (50%), followed by intermediate probability group (34,4%) and low probability group (15,6%). Highest increase in LVMI was obtained in the high probability group (93,8%), followed by intermediate probability (59,1%), and low probability group (10%) respectively. There was significant correlation between NFS and LVMI (P 0,002). Logistic regression showed that NFS has a more significant correlation with LVMI compared to gender (P=0,002).

Conclusion: NFS is a non‐invasive liver fibrosis scores which independently corelated with Left ventricular mass index (LVMI), a marker of cardiovascular abnormality.

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Keywords: NAFLD; NFS; LVMI; NFS with LVMI; NFS with LVMI in NAFLD

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  1. Sesti G, Sciacqua A, Fiorentino TV, Perticone M, Succurro E, Perticone F. Association between noninvasive fibrosis markers and cardio-vascular organ damage among adults with hepatic steatosis. PLoS One. 2014;
  2. Azzam H, Malnick S. Non-alcoholic fatty liver disease - The heart of the matter. World Journal of Hepatology. 2015
  3. Adams LA, Lindor KD. Nonalcoholic Fatty Liver Disease. Annals of Epidemiology. 2007
  4. Harrison SA, Gawrieh S, Roberts K, Fournier C, Paredes AH, Alkhouri N. Prospective evaluation of the prevalence of non-alcoholic fatty liver disease and steatohepatitis in a large middle-aged US cohort. J Hepatol [Internet]. 2021; Available from:
  5. Chalasani N, Younossi Z LJ. Diagnosis and Management of Nonalcoholic Fatty Liver Disease : Practice Guidelines by AASLD, ACG, AGA. Am J Gastroenterol. 2012;55:2005–23
  6. Targher G, Day CP, Bonora E. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. New England Journal of Medicine. 2010
  7. Hasan I LL. Prevalence and Risk Factors for Nonalcoholic Fatty Liver in Indonesia. Pertem Ilm Tah XIV PPHI. 2007;
  8. Sasdesi L. Data Kunjungan Pemeriksaan Ultrasonografi Abdomen Instalasi Radiologi RSUP Dr Kariadi Semarang. 2010
  9. Arturi F, Succurro E, Procopio C, Pedace E, Mannino GC, Lugarà M, et al. Nonalcoholic fatty liver disease is associated with low circulating levels of insulin-like growth factor-I. J Clin Endocrinol Metab. 2011;
  10. Sesti G, Fiorentino T V., Hribal ML, Sciacqua A, Perticone F. Association of hepatic insulin resistance indexes to nonalcoholic fatty liver disease and related biomarkers. Nutr Metab Cardiovasc Dis. 2013;
  11. Ballestri S, Lonardo A, Bonapace S, Byrne CD, Loria P, Targher G. Risk of cardiovascular, cardiac and arrhythmic complications in patients with non-alcoholic fatty liver disease. World J Gastroenterol. 2014;
  12. Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: Natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med. 2011;
  13. VanWagner LB, Wilcox JE, Ning H, Lewis CE, Carr JJ, Rinella ME, et al. Longitudinal Association of Non-Alcoholic Fatty Liver Disease With Changes in Myocardial Structure and Function: The CARDIA Study. Vol. 9, Journal of the American Heart Association. 2020
  14. Pacifico L, Chiesa C, Anania C, De Merulis A, Osborn JF, Romaggioli S, et al. Nonalcoholic fatty liver disease and the heart in children and adolescents. World Journal of Gastroenterology. 2014
  15. Hallsworth K, Hollingsworth KG, Thoma C, Jakovljevic D, Macgowan GA, Anstee QM, et al. Cardiac structure and function are altered in adults with non-alcoholic fatty liver disease. J Hepatol. 2013;
  16. Pacifico L, Di Martino M, De Merulis A, Bezzi M, Osborn JF, Catalano C, et al. Left ventricular dysfunction in obese children and adolescents with nonalcoholic fatty liver disease. Hepatology. 2014;
  17. Bonci E, Chiesa C, Versacci P, Anania C, Silvestri L, Pacifico L. Association of nonalcoholic fatty liver disease with subclinical cardiovascular changes: A systematic review and meta-analysis. BioMed Research International. 2015
  18. Treeprasertsuk S, Björnsson E, Enders F, Suwanwalaikorn S, Lindor KD. NAFLD fibrosis score: A prognostic predictor for mortality and liver complications among NAFLD patients. World Journal of Gastroenterology. 2013
  19. Kim D, Kim WR, Kim HJ, Therneau TM. Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States. Hepatology. 2013;
  20. Purnomo HD, Mundhofir FEP, Kasno, Sudijanto E, Darmono, Daldiyono, et al. Combination of Aspartate Aminotranferase and Tumor Necrosis Factor-α as Non Invasive Diagnostic Tools for Non Alcoholic Steatohepatitis (NASH). Acta Med Indones. 2015;
  21. Stepanova M, Younossi ZM. Independent Association Between Nonalcoholic Fatty Liver Disease and Cardiovascular Disease in the US Population. Clin Gastroenterol Hepatol. 2012;
  22. Makker J, Tariq H, Bella JN, Kumar K, Chime C, Patel H, et al. Preclinical cardiac disease in nonalcoholic fatty liver disease with and without metabolic syndrome. Am J Cardiovasc Dis [Internet]. 2019;9(5):65–77. Available from:
  23. Douglas L, Zaigham A, Frank A, Peter F, Aamir G, Khean L SH et al. Nonalcoholic Fatty Liver Disease and Nonalcoholic steatohepatitis. World Gastroenterol Organ Glob Guidel. 2012;3
  24. Leite NC, Villela-Nogueira CA, Salles GFC, Pannain VL, Caroli-Bottino A, Cardoso CRL. Prevalence of histopathological diagnosis of steatohepatitis and fibrosis in Type 2 diabetes and interobserver agreement using Kleiner classification. Hepatology. 2009;
  25. Ekstedt M, Franzén LE, Mathiesen UL, Thorelius L, Holmqvist M, Bodemar G, et al. Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology. 2006;
  26. Chen CH, Huang MH, Yang JC, Nien CK, Yang CC, Yeh YH, et al. Prevalence and etiology of elevated serum alanine aminotransferase level in an adult population in Taiwan. J Gastroenterol Hepatol. 2007;
  27. Dowman JK, Tomlinson JW, Newsome PN. Pathogenesis of non-alcoholic fatty liver disease. QJM. 2009
  28. Hashizume H, Sato K, Yamazaki Y, Horiguchi N, Kakizaki S, Mori M. A prospective study of long-term outcomes in female patients with nonalcoholic steatohepatitis using age- and body mass index-matched cohorts. Acta Med Okayama. 2013;
  29. Miller A, McNamara J, Hummel SL, Konerman MC, Tincopa MA. Prevalence and staging of non-alcoholic fatty liver disease among patients with heart failure with preserved ejection fraction. Sci Rep [Internet]. 2020;10(1):1–9. Available from:
  30. Singh GK, Vitola BE, Holland MR, Sekarski T, Patterson BW, Magkos F, et al. Alterations in ventricular structure and function in obese adolescents with nonalcoholic fatty liver disease. J Pediatr. 2013;
  31. Lee H, Kim G, Lee YH. Association between non-alcoholic steatohepatitis and left ventricular diastolic dysfunction in type 2 diabetes mellitus. Diabetes Metab J. 2020;44(3):486–7
  32. Chiu LS, Pedley A, Massaro JM, Benjamin EJ, Mitchell GF, McManus DD, et al. The association of non-alcoholic fatty liver disease and cardiac structure and function—Framingham Heart Study. Liver Int. 2020;40(10):2445–54
  33. Hu KC, Wang HY, Liu SC, Liu CC, Hung CL, Bair MJ, et al. Nonalcoholic fatty liver disease: Updates in noninvasive diagnosis and correlation with cardiovascular disease. World J Gastroenterol. 2014;
  34. Bhatia LS, Curzen NP, Calder PC, Byrne CD. Non-alcoholic fatty liver disease: A new and important cardiovascular risk factor? European Heart Journal. 2012
  35. Targher G, Valbusa F, Bonapace S, Bertolini L, Zenari L, Rodella S, et al. Non-Alcoholic Fatty Liver Disease Is Associated with an Increased Incidence of Atrial Fibrillation in Patients with Type 2 Diabetes. PLoS One. 2013;

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