Hypertension and diabetes mellitus are associated with high FIB-4 index in a health checkup examination cohort without known liver disease

Background: Non-alcoholic fatty liver disease (NAFLD) is usually asymptomatic and lacks a specific biomarker; therefore, many individuals might remain undiagnosed even with advanced liver fibrosis. The aim of this study was to clarify the prevalence and clinical features of subjects with a high risk of advanced liver fibrosis in the general population, using the Fibrosis-4 (FIB-4) index. Methods: : We retrospectively investigated 6,183 subjects without known liver disease who had participated in an annual health checkup examination. We analyzed the factors associated with high FIB-4 index (≥2.67) using a logistic regression analysis. Results: : Among the 6,183 subjects, 76 (1.2%) had high FIB-4 index. Multivariate analysis identified hypertension (odds ratio [OR]=8.926; 95% confidence interval [CI] 4.031-19.768; P<0.001) and diabetes mellitus (OR=4.045; 95% CI 1.694-9.660; P=0.002) as important risk factors for high FIB-4 index. The rates of hypertension and diabetes mellitus in subjects with high FIB-4 index were 78.9% and 23.7%, respectively. No significant association was observed between obesity or large waist circumference and a high FIB-4 index. A history of cardiovascular disease was significantly more common in subjects with high FIB-4 index. These results were also observed in subjects with normal aminotransferase (ALT) levels. Conclusions: : The present study revealed that approximately 1% of the general Japanese population has a high risk of advanced liver fibrosis. Many of these patients had hypertension and/or diabetes mellitus. Our findings suggest that there are many undiagnosed NAFLD patients with risk of advanced liver fibrosis in the general population.