The impact of nonalcoholic fatty liver disease in combination with type 2 diabetes and obesity on early liver fibrosis following FIB-4 index screening postprint

Abstract: Background　With the prevalence of obesity，the incidence of non-alcoholic fatty liver disease（NAFLD） is increasing，the risk of liver fibrosis and liver cancer is also increasing. Screening for early fibrosis is of great significance. International guidelines recommend fibrosis-4 （FIB-4） index as an indicator for screening liver fibrosis. However，it is unclear whether FIB-4 index screening is affected by type 2 diabetes and BMI in screening for early fibrosis. Objective To evaluate whether the effectiveness of FIB-4 index in primary care screening is affected by type 2 diabetes and BMI. Methods　A total of 110 patients diagnosed with NAFLD by liver biopsy in the Affiliated Hospital of Hangzhou Normal University from 2013 to 2023 were selected as the study objects. They were divided into type 2 diabete（T2DM） group and non-T2DM group according to T2DM. According to BMI，they were divided into normal weight group，overweight group and obesity group. According to the liver biopsy results，they were divided into F0-F1 group and F2-F4 group. FIB-4 index was calculated and the differences among each group were compared. Pearson correlation was used to analyze the correlation between FIB-4 index and various metabolic indexes. The accuracy of FIB-4 index was evaluated via receiver operating characteristics （ROC） curves. Results　The comparison results ofFIB-4 index showed that the T2DM group was higher than non-T2DM group，and F0-F1 group was lower than F2-F4 group with statistical significance （P<0.05）. There was no significant difference in FIB-4 index among normal weight group，overweight group and obesity group （P>0.05）. Correlation analysis showed that FIB-4 index was positively correlated with age，AST and fibrosis （P<0.05），and negatively correlated with platelet count （P<0.05）. FIB-4 index=1.3 was used as the tangency point to predict early NAFLD liver fibrosis，results showed that there was no significant difference in AUC between T2DM and non#2;T2DM group （P>0.05）. The AUC value of FIB-4 index in the normal weight group was higher than overweight group，and the difference was statistically significant （P<0.05）. There was no significant difference among the obesity group，overweight group and normal weight group （P>0.05）. Conclusion　FIB-4 is not affected by T2DM in the assessment of early fibrosis in NAFLD patients，but has a certain relationship with BMI.