fibroscan score fatty liver cap

Liver congestion (when your liver is too full of blood or other fluids). The measurement of fatty change in your liver is the CAP score, while the measurement of scarring is the fibrosis score. CAP Score Steatosis grade Portion of your liver affected by fatty change 238 to 260 dB/m S1 Less than (11% to 33%) 260 to 290 dB/m S2 Between and (34% to 66%) 290 to 400 dB/m S3 More . This cross sectional study was conducted in 30 to 53-year-old individuals with concurrent T2DM and NAFLD (controlled attenuation parameter score260dB/m). Sci Rep. 2022 Dec 19;12(1):21897. doi: 10.1038/s41598-022-25931-7. Outpatient Percutaneous Endoscopic Gastronomy, Endoscopic Retrograde Cholangio-Pancreatography (ERCP). Monday to Friday, 8 a.m. to 6 p.m. (Eastern time), Monday to Friday, 9 a.m. to 5 p.m. (Eastern time). J. Appl. To ensure hydration and obtain a valid evaluation, subjects were asked to follow the instructions before the body composition assessment as previously described27. Araiza et al. Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes. /Annots 15 0 R QMA was supported by the NIHR Newcastle BRC. A FibroScan can reveal fatty changes to the liver (steatosis) and scarring. | Arq Gastroenterol, 2018. /ca 1.0 Am. J. Phys. Some possible mechanisms that explain the relationship between BMR and blood pressure are as follows: (1) increased activity of the sympathetic nervous system, which can elevates BMR and blood pressure64,65; (2) thyroid hormones levels (T3 and T4) which can affect both blood pressure and metabolism64,66; (3) accumulation of reactive oxygen species (ROS) related to the oxidative stress conditions that can elevate BMR and also increase blood pressure through endothelial dysfunction, inflammation and changes in the regulation of nitric oxide64,67,68. J. Clin. Your fibrosis result may be over-estimated (your liver may have less scarring than what your fibrosis result says) if you have: Your FibroScan results may also be less accurate if you have: Fibrosis score F0 to F1: No liver scarring or mild liver scarring, Fibrosis score F2: Moderate liver scarring, Fibrosis score F3: Severe liver scarring Fibrosis score. The shaded area indicates 95% CI. Brsik, M. et al. Fibroscan Score Fatty Liver CapFatty liver is a condition that causes the body's liver cells to swell up, known as fibrosis. There is some evidence suggesting the increased basal metabolic rate (BMR) in subjects with T2DM14,15 and liver diseases16,17. Clipboard, Search History, and several other advanced features are temporarily unavailable. The current study suggested that adiponectin was a strong positive determinant for REE in individuals with NAFLD and T2DM. The LSM and CAP measurements are carried out simultaneously, and the median values of more than ten valid measurements are used to quantify liver . FibroScan works similarly to an ultrasound, emitting a small pulse of energy, called a shear wave. The AUROCs of the CAP for 5%, >33% and >66% steatosis were 0.79, 0.76 and 0.70, respectively. This study showed that both NFS and FIB-4 score were similar in patients with fibrosis stages 0 and those with fibrosis stages 1 ( p > 0.05). The FAT in the liver is measured by the Controlled Attenuation Parameter - CAP. Energy expenditure and substrate utilization in older women after strength training: 24-h calorimeter results. Your fibrosis result is a measurement of the amount of scarring in your liver. Based on our literature review, this research, for the first time, addressed the relationship between adiponectin and hypermetabolism among individuals with both T2DM and NAFLD. Would you like email updates of new search results? 11 0 obj Non-alcoholic fatty liver disease: A major challenge in type 2 diabetes mellitus. Liver biopsy is crucial for selecting patients with non-alcoholic steatohepatitis (NASH) for inclusion in clinical trials and, by implication, for treatment after new drugs are licensed. This information should not be used as a substitute for professional diagnosis or treatment. Resting energy expenditure is not increased in mildly hyperglycaemic obese diabetic patients. A fibrosis score of F3 (10 to 14 kPa) indicates severe scarring which has spread and disrupts normal blood flow. << Lifestyle modification improves the hepatic steatosis, and CAPcan be used to detect the improvement of hepatic steatosis during follow-up in patients with NAFLD on lifestyle modification. This is usually caused by heart failure. By submitting a comment you agree to abide by our Terms and Community Guidelines. Thirdly, the wide availability of FibroScan devices based on VCTE technology, the need for just a serum AST value, its non-invasive nature, its low cost per scan, and its modest requirement to attain technical proficiency required to do the scans, mean the method can be rolled out easily across most clinical practices. Lombardo, M. et al. << 64(3 Suppl), 449s452s (1996). Please do not use it to ask about your care. 20(3), 23872391 (2020). Hepatology 64(1), 7384 (2016). >> 4) The spleen-strengthening and liver-draining herbal formula treatment of non-alcoholic fatty liver disease by regulation of intestinal flora in clinical trial. In addition, JFC has a patent pending for protein-based biomarkers of fatty liver disease. Hipskind, P. et al. * CAP for pediatric patients with liver disease is only available with SmartExam capability. Read across the row from left to right until you find the range that includes your fibrosis result. Med. You may have less scarring than your results suggest. Careers. MB), Help with To assess the health of your liver, your doctor may recommend a FibroScan test, which is an ultrasound of the liver. FibroScan can be used on patients in need of staging of their NAFLD/NASH, whether their condition is suspected or biopsy-confirmed. 2023 Feb 19;13(4):788. doi: 10.3390/diagnostics13040788. The formulas used were the HSI (hepatic steatosis index), FLI (fatty liver index), and the NAFLD fibrous score . CAPis a quantitative surrogate of liver steatosis expressed in decibel per meter (db/m). To use the table, find the liver disease that you have on the left side of the table. Nat. Piaggi, P. et al. Am. FibroScan is an imaging-based diagnostic test developed by Echosens that looks at liver fibrosis (stiffness, scarring) and steatosis (fat) using transient-elastography technology. endobj The liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) determined using FibroScan are the evidence-based non-invasive measures of liver fibrosis and steatosis, respectively. CAP is unique, patented and validated for liver steatosis assessment 2,3: 822 international and peer-reviewed articles support the use of CAP. PubMed A fibrosis score of F2 (7.5 to 10 kPa) indicates moderate scarring that has spread outside the liver. /PCSp 4 0 R FibroScan powered by CAP CAP (Controlled Attenuation Parameter) is the non-invasive reference parameter to diagnose and monitor liver steatosis. Ann. Variables with a p-value<0.2 in univariate analysis were enteredinto the multivariate model using the backward selection approach. Opin. Benign (not cancerous) or cancerous tumors in your liver. J. Nutr. We look forward to being your partner in health! Factors related to hypermetabolism in individuals with type 2 diabetes mellitus and non-alcoholic fatty liver disease. Eddowes PJ, Sasso M, Allison M, Tsochatzis E, Anstee QM, Sheridan D, Guha IN, Cobbold JF, Deeks JJ, Paradis V, Bedossa P, Newsome PN. Frequency and outcomes of liver transplantation for nonalcoholic steatohepatitis in the United States. Body composition was estimated by a bioelectrical impedance scale (BC 418 MA, Tanita, Japan). Med. Correspondence to Nephrol. PubMed Central Clayton-Chubb D, Kemp W, Majeed A, Lubel JS, Hodge A, Roberts SK. C(aL}%:f~m5"=&@M*M2*38"% Deurenberg, P. Limitations of the bioelectrical impedance method for the assessment of body fat in severe obesity. At given FAST score cutoffs, it is possible to graphically assess the screen failure rate and missed cases rate together with the proportion of patients above the FAST score who would be given liver biopsy in the context of patients screening in drug trials for NASH. J. Obes. Google Scholar. A. Type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) are both progressive health problems worldwide1,2. A fibroscan score is a numerical result between 2-75. The French bariatric surgery (A), USA screening (B), Chinese Wenzhou NALFD (D), and the Malaysian NAFLD (F) cohort have a range of prevalence of NASH+NAS4+F2 (9% to 20%), which is lower than the derivation cohort. The median CAP was higher among patients with significant steatosis (317 [IQR 284-339] vs. 250 [227-279] dB/m with <10% steatosis; P < 0.0005) and the AUROC for this outcome was 0.81 (95% CI 0.74-0.88). Between September, 2017, and March, 2018, a total of 108 subjects with both T2DM and NAFLD who met the inclusion criteria and were willingness to participate in the study were recruited from diabetes clinics in the Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences (Tehran, Iran). Nutr. AUROC=area under the receiver operating curve. and JavaScript. Esser, N. et al. Depending on where you get a FibroScan may determine the scoring system used in your diagnosis. 258(6), E990E998 (1990). All authors have read the manuscript and approved the manuscript. To use the table, find the liver disease that you have on the left side of the table. Inactivity and obesity are two of the biggest contributors to liver disease that is not due to heavy alcohol use. 477.750000 0] FibroScan Fat Results What does the FAT (CAP) Score mean? Syndr. CAS Investig. The Fatty Liver Foundation, its officers or contributors expressly disclaim responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site. This score will range from 100 dB/m to 400 dB/m. J. Behav. Sports Sci. Int. Ultrasonography and FibroScan were performed twice and once, respectively ( Table 5 ). Depending upon the reason fatty liver; S1, S2, S3 range differs. CAP value of 300 falls into S2/S3 stage. image, Download .pdf (.32 2023 Jan 29;15(3):687. doi: 10.3390/nu15030687. If you're a patient at MSK and you need to reach a provider after. It shows how much of your liver is affected by fat buildup. Some studies have suggested that the diabetes per se, not the level of glucose level, is a major determinant of high REE in diabetic subjects37. Independent sample t-test, MannWhitney U test or Chi-square (2) test was used for comparison between groups as appropriate. Int. Med. Echosens and UK National Institute for Health Research. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. endobj This can happen if you have: FibroScan may give less accurate results, or no results at all if you have: Your healthcare provider may use imaging tests, such as ultrasound, CT, or MRI, to see your liver. He decided to order a Fibroscan to rule out any liver disease. Care 6(1), 5563 (2003). Use of FAST in primary care will require investment in devices and personnel, although there are many examples of such models being introduced successfully. Article Gynecol. The main causes of fatty liver disease are excessive alcohol consumption and/or poor diet and sedentary lifestyle. Controlled Attenuation Parameter (CAP): a noninvasive method for the detection of hepatic steatosis based on transient elastography World J. Gastroenterol. ET reports personal fees from Pfizer, Intercept, Gilead, Promethera, and Dr Falk, outside the submitted work. Tarantino, G. et al. Your CAP score and steatosis grade can go up or down over time. sharing sensitive information, make sure youre on a federal Diabetes Care 40(3), 419430 (2017). Your CAP score is measured in decibels per meter (dB/m). Here are some helpful terms to know related to your FibroScan results: Fibrosis (fy-BROH-sis): Scarring in your liver. Mansour, A., Motamed, S., Hekmatdoost, A. et al. JJD, AP, M-HZ, PJE, DAS, ING, and VP declare no competing interests. 12, 20420188211055556 (2021). /Creator ( w k h t m l t o p d f 0 . In the meantime, to ensure continued support, we are displaying the site without styles [/Pattern /DeviceRGB] BMR is defined as the amount of energy the body consumes at complete rest in a thermally neutral environment after 1012h of fasting and a night sleep18. Therefore, the objective of the present study was to find the predictive or determining factors that could affect hypermetabolism in subjects with both T2DM and NAFLD. CAS A mild fatty liver is over 5% but less than 33%. The data about demography, past medical history and drug consumption were collected through face-to-face interviews. It is important to remember that the ranges in the table are estimates, and your actual fibrosis score may not match what the table says. Strength training increases resting metabolic rate and norepinephrine levels in healthy 50-to 65-yr-old men. YY reports grants and speaker fees/advisory board fees from Gilead Sciences; and speaker fees/advisory board fees from Bilim la, AbbVie, and Abdi brahim outside the submitted work. This means that your actual fibrosis score (the score that your healthcare provider tells you) may not match the fibrosis score in the table. Liver stiffness measurement (LSM) by vibration-controlled transient elastography and controlled attenuation parameter (CAP) measured by FibroScan device were combined with aspartate aminotransferase (AST), alanine aminotransferase (ALT), or AST:ALT ratio. We have over 20 locations across California, which makes it easy and convenient for our patients to schedule their appointments. SC reports grants from Echosens to his institution (APHP) during the conduct of the study and speaker fees/advisory board fees from MyGoodLife outside the submitted work. KPa score 44.2 CAP score 309. The information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. /XObject << Protein turnover is assumed to account for 20% of REE in healthy subjects41, and elevated protein turnover is associated with increased REE42,43 and loss of FFM43. suOhx>?oA\{G)Mght What it measures: fibrosis, steatosisWho should take it: undiagnosed and diagnosed NAFLD/NASH patientsWhere to get it: specialty care centers, hospitals, some primary care providers. Renal Physiol. Study conception and design, Analysis and interpretation of data, Drafting of manuscript, Critical revision. /Contents 12 0 R There are three stages if fatty liver as per CAP value: S1, S2, S3. Moreover, some studies have indicated serum adiponectin is negatively correlated with REE in Caucasians54 and Pima Indians55. Hepatology 48(4), 10871096 (2008). Hepatol. BMI was calculated as weight in kg divided by the square of height in meters. & Groop, L. Factors associated with basal metabolic rate in patients with type 2 (non-insulin-dependent) diabetes mellitus. Your CAP score is a measurement of fatty change in your liver. From diagnosis to treatment, our experts provide the care and support you need, when you need it. There is also evidence showing that resistance training programs increases REE71,72,73,74. The ranges of fibrosis results in the table are estimates. J Gastroenterol Hepatol. (F) Malaysian NAFLD cohort (n=176). Nutr. Considering the progressive prevalence and co-occurrence of type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD), as well as the current evidence suggesting the elevated levels of basal metabolic rate (BMR) among these individuals, the present study aimed to identify factors determining hypermetabolism in such subjects. TE was performed using the Fibroscan apparatus. The CAP is a promising tool for the noninvasive detection of hepatic steatosis. | Clinical and Translational Gastroenterology, 2016. Ther Adv Endocrinol Metab. It ranges from 100 to 400 dB/m. Memorial Sloan Kettering was founded in 1884, and today is a world leader in patient care, research, and educational programs. Is obesity associated with altered energy expenditure? Clin. The calibration plot characterises the agreement between observed proportion and predicted probabilities. There is a silent epidemic of fatty liver disease in the general population, called NAFLD/NASH. Proportion of NAFLD patients with normal ALT value in overall NAFLD patients: A systematic review and meta-analysis. 0. Waist circumference (WC) was measured at the midpoint between the lower costal margin and the iliac crest. Expert Rev. 6(1), 19 (2005). Prevalence of NASH+NAS4+F2=57%. Lancet Gastroenterol Hepatol. Doc says there is no need to do a biopsy at this point given the unremarkable or reassuring other test results. Natl. In general, some variables including age, sex, race, weight, height and body composition have been recognized as the most important predictive factors for BMR19. In contrast, FFM was negatively related to hypermetabolism (OR 0.93, 95% CI 0.880.99, p=0.023). These devices are designed for use in a medical practice in order to measure liver stiffness and ultrasound attenuation in patients with liver disease. 85(1), 2634 (2007). Google Scholar. Sign up for the Nature Briefing newsletter what matters in science, free to your inbox daily. In summary, we believe the FAST score will allow for the more efficient identification of an at-risk group of patients with progressive NASH that merit consideration for further treatment. The prevalence of T2DM among NAFLD and non-alcoholic steatohepatitis (NASH) cases has been reported to be 22.5% and 43.6%, respectively6. Ruige, J. and transmitted securely. Epub 2021 Sep 14. Shear wave speed and stiffness, and CAP* may be used as an aid in the clinical management of pediatric patients with liver disease. Also, few studies have been designed to determine BMR in subjects with liver disease17. PubMed Bril, F. & Cusi, K. Management of nonalcoholic fatty liver disease in patients with type 2 diabetes: A call to action. Association of adiponectin level and variants in the adiponectin gene with glucose metabolism, energy expenditure, and cytokines in offspring of type 2 diabetic patients. In a casecontrol study matched for sex, age, and body mass index (BMI), NAFLD cases had higher REE when compared to controls16. We found that the higher level of ALT was an independent factor predicting hypermetabolism in T2DM individuals with NAFLD. /F6 6 0 R Effect of bariatric surgeries on metabolic rate, a systematic review and meta-analyses. BMC Nephrol. We use cookies to help provide and enhance our service and tailor content and ads. eCollection 2023 Jan. Taru MG, Neamti L, Taru V, Procopciuc LM, Procopet B, Lupsor-Platon M. Diagnostics (Basel). Published by Elsevier Ltd. Article In accordance with our findings, Ali et al.63 and Snodgrass et al.64 showed a direct relationship between BMR and blood pressure. An official website of the United States government. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Rehabil. gold standard solution for comprehensive management of liver health, Enhance FibroScan liver disease assessment with biological markers, Your everyday FibroScancompanion free application, Optimize clinical workflows with real-time secure data transmission. PNN, MS, CF-P, and JJD wrote the manuscript. Transplant 17(2), 216221 (2002). A blood-based biomarker panel (NIS4) for non-invasive diagnosis of non-alcoholic steatohepatitis and liver fibrosis: a prospective derivation and global validation study. J. Physiol.-Endocrinol. Filed Under: FibroScan Tagged With: FibroScan Testing, FibroScan Testing in California, FibroScan Testing near me, gastroenterologist clinic, gastroenterologist clinic in California, gastroenterologist clinic near me, gastroenterologist in California, gastroenterologist near me, inSite Digestive Health Care. -, Sanyal AJ. 90(7), 42164223 (2005). How to Identify Advanced Fibrosis in Adult Patients with Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH) Using Ultrasound Elastography-A Review of the Literature and Proposed Multistep Approach. PubMed Central Enhanced levels of whole-body protein turnover in patients with chronic obstructive pulmonary disease. Resting metabolic rate is an important predictor of serum adiponectin concentrations: Potential implications for obesity-related disorders. Please enable it to take advantage of the complete set of features! Prevalence of NASH+NAS4+F2=12%. NAFLD in type 1 diabetes: Overrated or underappreciated? B. et al. 91(4), 16001603 (2006). Google Scholar. Our highly-specialized educational programs shape leaders to be at the forefront of cancer care and research. Nat Rev Gastroenterol Hepatol. 14(7), 837852 (2021). Nutr. However, the literature represents diverse findings in regard to adiponectin levels and REE. Eddowes PJ, Sasso M, Allison M, Tsochatzis E, Anstee QM, Sheridan D, Guha IN, Cobbold JF, Deeks JJ, Paradis V, Bedossa P, Newsome PN. Sasso M, Miette V, Sandrin L, Beaugrand M. Clin Res Hepatol Gastroenterol. Anthropol. The two biggest risk factors for liver scarring are alcohol abuse and diseases like hepatitis. Hepatol. PubMed Central Twenty-four-hour energy expenditure in Pima Indians with type 2 (non-insulin-dependent) diabetes mellitus. JFC reports speaker fees/advisory board fees from EchoSens during the conduct of the study; and personal fees from NovoNordisk, Intercept, and Alnylam, outside the submitted work. 2020 The Author(s). Am. The effect of omega3 fatty acid supplementation on PPAR and UCP2 expressions, resting energy expenditure, and appetite in athletes. FLF Launches a Public-Private Partnership to Combat the Silent Epidemic of NAFLD, FLF and Fibronostics form a patient education partnership, Echosens Aligns with FLF to Accelerate Screening for Undiagnosed NAFLD and NASH, Fatty Liver Foundation Launches the State of NAFLD/NASH Care in America Initiative to Support Improved Patient Care Experience, FATTY LIVER FOUNDATION TO MARK INTERNATIONAL NASH DAY WITH THREE INTERACTIVE PROGRAMS OFFERING INFORMATION, INSPIRATION, AND SUPPORT FOR PEOPLE AT-RISK OF OR LIVING WITH NAFLD/NASH. %PDF-1.4 The highest possible result is 75 kPa. 14 0 obj J. Pediatr. American Diabetes Association. Ali, N. et al. Echosens and UK National Institute for Health Research. Association between uncoupling protein 2, adiponectin and resting energy expenditure in obese women with normal and low resting energy expenditure. /SA true In non-alcoholic fatty liver disease (NAFLD), advanced liver fibrosis is excluded by normal liver stiffness, but a wide range of cutoffs have been used to predict advanced liver fibrosis or cirrhosis. Rep. 5(6), 513520 (2003). Pract. J. Clin. In addition, there is an intricate and reciprocal association between T2DM and NAFLD3,4,5. Liver scarring is a serious condition and can lead to life-threatening complications if not addressed. Hui D, Liu L, Azami NLB, Song J, Huang Y, Xu W, Wu C, Xie D, Jiang Y, Bian Y, Sun M. Front Endocrinol (Lausanne). Among anthropometric measures, including height, weight, BMI, fat mass, fat percent, fat free mass (FFM), total body water (TBW) and WC, only TBW was significantly higher in subjects with non-hypermetabolism, as compared with hypermetabolism subjects (46.158.09 vs. 42.098.47, p=0.027). Endocrinol. FibroScan can be used on patients in need of staging of their NAFLD/NASH, whether their condition is suspected or biopsy-confirmed. NASH=non-alcoholic steatohepatitis. Article CAP is unique, patented and validated for liver steatosis assessment2,3: 822 international and peer-reviewed articles support the use of CAP. The enzyme-linked immunosorbent assay (ELISA) kit (Roche, Germany) was used to measure the serum concentration of liver enzymes, creatinine, high-sensitive C-reactive protein (hs-CRP) and lipids. 35(8), 19831991 (2015). 4 0 obj /Length 13 0 R Factors related to hypermetabolism in individuals with type 2 diabetes mellitus and non-alcoholic fatty liver disease, https://doi.org/10.1038/s41598-023-30945-w. Get the most important science stories of the day, free in your inbox. Roll-out is further aided by the free availability of the equation, which is also accessible through an app. @Ev*B{p\Qk[Ll0T!]\3# Article This site needs JavaScript to work properly. Google Scholar. One study found that adiponectin concentration had no relationship with energy expenditure among non-diabetic subjects52. Hypertension prevalence and influence of basal metabolic rate on blood pressure among adult students in Bangladesh. Indirect calorimetry in clinical practice. CAS (Fatty liver) 3. A healthy liver has a CAP score of 5% or lower. Thank you for visiting nature.com. Fatty Liver Foundation copyright 2023 all rights reserved. 61(5), 469 (2012). A total of 153 patients were included: 69% were male, median BMI was 32 kg/m(2); 47% had nonalcoholic fatty liver disease (NAFLD); and 65% had significant (10%) steatosis. You can keep reading to learn more about your results. Overall, the mean recruitment agestandard deviation and median (interquartile range) body mass index were 44.695.47years and 30.20 (27.8033.30) kg/m2, respectively. According to the results of multivariable logistic regression analysis (Table 2), hypermetabolism was positively associated with adiponectin (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.021.34, p=0.030), physical activity (OR 1.13, 95% CI 1.0021.28, p=0.046), ALT (OR 1.06, 95% CI 1.0061.12, p=0.031) and diastolic blood pressure (OR 1.07, 95% CI 1.011.13, p=0.021). Do handheld calorimeters have a role in assessment of nutrition needs in hospitalized patients? Delsoglio, M. et al. Today, in most studies, as well as in clinical practice, resting energy expenditure (REE), also known as resting metabolic rate (RMR), is used as an estimate of BMR, because it requires less restrictive conditions18,20. Follow the row that has your results. Your healthcare provider will use your FibroScan fibrosis result and your medical history to determine your fibrosis score. Zheng, Y., Ley, S. H. & Hu, F. B. WP%n. $ #B :5AAs/8@lJ(V!GGc\ek5BiPlE~{;D[j1">2D(nPc=/OVE\A6xyQv xolK )E-M CWs]9P];&RL{y^|KnMTB%VO{ipgx;DG_v/@[iKc{39:Gq`%L,OHuNQ Xb+rL~ -9sR^I2= &L-tx\t1tpTj|TT;5Y5xaG>0C(n(\2*ynlXAm3??-q`]e~{Z4 dq`8l^ooA1zWQ,JEBudgdqGVR9J@y@yZG&y~X9 pxJTz|PN(u0[$2cRKm!t(!0COwPjv+WPP%8r Q Written informed consent was obtained from all participants. Comparison of hepatic steatosis index as noninvasive diagnostic tool and liver ultrasound for non-alcoholic steatosis in the adult population.

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