Abstract C090: Community-based screening for nonalcoholic fatty liver disease with transient elastography in Latinos without overt liver disease at high risk of hepatocellular carcinoma
Authors: Hussain Shehnaz , Benhammou Jihane 
Published: September 2020

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a disease spectrum that progresses through stages of liver fibrosis, cirrhosis, and ultimately hepatocellular carcinoma (HCC). NAFLD has more than doubled in incidence over the last decade alongside the obesity pandemic, and Latinos are at least twice as likely to be affected. The key clinical challenge is how to efficiently screen high-risk communities to identify individuals with severe steatosis and advanced fibrosis or cirrhosis who would benefit from lifestyle modifications, therapeutics, or cancer surveillance. A high proportion of patients with NAFLD are asymptomatic for long periods of time with normal laboratory tests, thus non-invasive procedures for early identification are needed. Transient elastography (TE) is a validated non-invasive diagnostic tool which can identify patients with liver disease. Methods: From March-June 2019, we recruited 76 Latino participants attending a community health screening event in Los Angeles to determine the prevalence of undiagnosed liver disease. We utilized TE performed with a FibroScan® (Echosens) to produce liver stiffness measurement (LSM, a measure of fibrosis in kPa) and a controlled attenuation parameter (CAP, a measure of steatosis in dB/m) on fasting participants, and we collected a self-administered questionnaire for basic characteristics and past medical history, offered in Spanish or English. Results: A total of 74 participants had a valid test with a minimum of ten LSMs with an interquartile range/median value less than 0.3. The mean age of participants was 50 years, and 65% were female. For metabolic risk factors, 78% were overweight or obese, with a mean BMI of 29.5 kg/m2, and the percentage of participants with diabetes or high blood pressure was 29% and 15%, respectively. A minority of participants (4%) reported drinking alcohol 2-3 times per week or more. As for prior liver disease, 16% of participants reported a prior diagnosis of chronic liver disease: NAFLD (N=11), hepatitis B virus (N=1), or cholestatic disease (N=1). In subsequent analyses, we excluded participants with known liver disease. The TE data generated show that steatosis was present in 66% of participants (4% mild, 13% moderate, 49% severe steatosis), with a mean CAP of 273.9 dB/m. The mean LSM in this population was 5.8 kPa, with 22% of participants having kPa measure equivalent to a moderate fibrosis grade (F2 or greater). In univariate analyses, LSM was positively associated with BMI (P= 0.008) and CAP (P&lt;0.001); CAP was positive associated with age (P=0.004) and BMI (P&lt;0.001). In multiple linear regression, CAP (P=0.015), but not BMI, was significantly associated with LSM; and BMI (P&lt;0.001) and age (P&lt;0.002) were both significantly associated with CAP. Conclusion: This study demonstrates the feasibility of using TE at a community-based health screening in a high-risk population. We detected a high rate of clinically significant fibrosis and steatosis suggesting a high prevalence of undiagnosed NAFLD among Latinos.

Citation Format: Shehnaz Hussain, Jihane Benhammou. Community-based screening for nonalcoholic fatty liver disease with transient elastography in Latinos without overt liver disease at high risk of hepatocellular carcinoma [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C090.