The Deadly Duo: Visceral Fat and Diabetes as Key Predictors of Liver Fibrosis in Non-alcoholic Fatty Liver Disease

Background and Aim: NAFLD prevalence is increasing globally and is expected to become epidemic, especially in developing countries like India. Non-invasive methods for evaluation of NAFLD patients, including body composition analysis using bioelectrical impedance analysis (BIA), have gained interest. We aimed to identify factors associated with significant liver fibrosis, compare non-invasive scores, and derive a novel score based on clinical and BIA-derived variables. Methods: We analysed data from NAFLD patients seen at our outpatient department from February 2022 to March 2023. Patients underwent evaluations for various clinical and non-invasive measurements, including liver stiffness, body composition analysis, and metabolic measurements. We used binary logistic regression to identify factors associated with significant liver fibrosis and compared four commonly used non-invasive scores with a novel DVF15 score using statistical tests and ROC curves. Results: A total of 609 patients with NAFLD were included in the study. Patients with significant fibrosis had a higher proportion of type 2 diabetes (41% vs 21%, p<0.001), higher levels of AST, ALT, HbA1c, Fib-4 score, APRI score, and NFS score, and a higher percentage of visceral fat and subcutaneous fat compared to those without significant fibrosis. Binary logistic regression identified T2DM and visceral fat 15% as strongly and independently associated with significant liver fibrosis. A novel 2-point score (DVF15) was derived using T2DM and visceral fat 15%, and its performance was compared with other non-invasive scores. The area under the ROC curve of DVF15 was 0.664 (p<0.001), which was higher than Fib-4 score (0.607), APRI score (0.620), and NFS score (0.613). Conclusion: Our study found that type 2 diabetes and high visceral fat percentage are strongly and independently associated with significant liver fibrosis in NAFLD patients. We developed a novel DVF15 score that uses easily accessible variables to predict significant liver fibrosis with moderate accuracy. Future research is needed to validate our findings and investigate the utility of the DVF15 score in larger cohorts and different populations.