Nonalcoholic Fatty Liver Disease, Liver Fibrosis, and Utility of Noninvasive Scores in Patients With Acromegaly

NAFLD is a metabolical disorder and can lead to liver fibrosis. Because it is commonly seen, several noninvasive scores (NS) have been validated to identify high-risk patients. Patients with NAFLD were shown to have higher serum ANGPTL-8 levels.The risk of NAFLD is known insufficiently in acromegaly. Moreover, the utility of the NS and the link between NAFLD and ANGPTL-8 in acromegaly is unknown.Thirty-two acromegalic patients(n = 15, active(AA) and n = 17, controlled acromegaly(CA)) and 19 healthy controls were included. MRI-proton density fat fraction(MRI-PDFF) was used to evaluate hepatic steatosis, and MR elastography(MRE) to evaluate liver stiffness measurement(LSM). ANGPTL-8 levels were measured with ELISA.Median liver MRI-PDFF and NAFLD prevalence in AA were lower than in CA(p = 0.026 and p < 0.001, respectively). Median MRE-LSM were similar across groups. Of the NS, VAI(visceral adiposity index), FLI(fatty liver index), HSI(hepatic steatosis index), and TyG(triglyceride-glucose index) all showed positive correlation with the liver MRI-PDFF in the control group. However, only TyG significantly correlated with liver fat in the AA and CA groups. There was no correlation between traditional NAFLD risk factors (BMI, waist circumference, CRP, HOMA-IR, visceral adipose tissue) and liver MRI-PDFF in the AA and CA. Acromegalic patients with NAFLD had lower GH, IGF-1, and ANGPTL-8 levels than in those without NAFLD(p = 0.025, p = 0.011, and p = 0.036, respectively).Active acromegaly may protect from NAFLD due to high GH. In acromegalic patients, NAFLD risk cannot be explained with classical risk factors, hence additional risk factors must be identified. TyG is the best score to evaluate NAFLD risk. Lower ANGPTL-8 in acromegalic patients with NAFLD implies this hormone may be raised due to insulin resistance rather than being a cause for NAFLD.