J. Clin. 8600 Rockville Pike The main causes of fatty liver disease are excessive alcohol consumption and/or poor diet and sedentary lifestyle. Find the liver disease you have in the first column on the left. Univariate logistic regression analysis was used to identify potential variables that have an effect on hypermetabolism. Additionally, fibrosis staging may be confirmed . 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 Liver elastography is a non-invasive test your healthcare provider can use this to learn about your livers health. Proc. Metab. In general, some variables including age, sex, race, weight, height and body composition have been recognized as the most important predictive factors for BMR19. 2023 Jan 19;13:1107071. doi: 10.3389/fendo.2022.1107071. Publication Arslanow et al. Your healthcare provider will use your liver stiffness result and medical history to find out your fibrosis score. The Weir formula29 was then used to calculate REE. Diagnostic abilities of FAST score, fatty liver index, CAP, and BMI for fatty liver in patients with MAFLD and NAFLD . Oxygen species in the microvascular environment: Regulation of vascular tone and the development of hypertension. Current smoker was attributed to those who had smoked cigarette regularly in the past 6months. Res. Sugimoto K, Lee DH, Lee JY, Yu SJ, Moriyasu F, Sakamaki K, Oshiro H, Takahashi H, Kakegawa T, Tomita Y, Abe M, Yoshimasu Y, Takeuchi H, Choi BI, Itoi T. Radiology. Sci Rep 13, 3669 (2023). References are available in ourbibliography. J. Appl. In those four cohorts, the FAST score overestimates the probability of being NASH+NAS4+F2. The short version of the international physical activity questionnaire (IPAQ) was used to measure the physical activity of participants28. FibroScan elastography of liver tissue can easily detect patients with cirrhosis and fatty liver. Fibroscan Score Fatty Liver CapFatty liver is a condition that causes the body's liver cells to swell up, known as fibrosis. Liver inflammation. If you have more than one liver disease, you may not be able to use the table. The prevalence of NAFLD including liver steatosis and liver fibrosis in T2DM has been estimated to be more considerable3,7. We used FibroScan to detect the incidence of fatty liver and fibrosis in CHB patients, and to assess the correlation of FibroScan measurements with blood chemistry tests. 10 0 obj 2020, 116 (2020). Bariatr. J. Clin. Diagnostic performance in the derivation, Diagnostic performance in the derivation cohort of the FAST score for the diagnostic, Calibration plots in external validation, Calibration plots in external validation cohorts (A) French bariatric cohort (n=110). J. Physiol. A language and environment for statistical computing. These devices are designed for use in a medical practice in order to measure liver stiffness and ultrasound attenuation in patients with liver disease. Herrera-Amante, C. A. et al. Google Scholar. Lancet Gastroenterol Hepatol. 1 0 obj 16(38), 4773 (2010). Greer, R. et al. Surg. The table below shows ranges of CAP scores and the matching steatosis grade and amount of fatty change. CAPis a quantitative surrogate of liver steatosis expressed in decibel per meter (db/m). Sasso M, Miette V, Sandrin L, Beaugrand M. Clin Res Hepatol Gastroenterol. Shen F, Zheng RD, Mi YQ, Wang XY, Pan Q, Chen GY, Cao HX, Chen ML, Xu L, Chen JN, Cao Y, Zhang RN, Xu LM, Fan JG. PubMed Central (C) China Hong-Kong NAFLD cohort (n=83). The cells become scarred and cannot divide. 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. Plasma adiponectin levels are not associated with fat oxidation in humans. /Annots 15 0 R Brsik, M. et al. Sabounchi, N. S., Rahmandad, H. & Ammerman, A. Best-fitting prediction equations for basal metabolic rate: Informing obesity interventions in diverse populations. Article Nutr. Most patients with the presence of a metabolic syndrome. Please do not write your name or any personal information on this feedback form. Google Scholar. Comparison of hepatic steatosis index as noninvasive diagnostic tool and liver ultrasound for non-alcoholic steatosis in the adult population. 12(5), 840845 (2004). Triangles represent deciles of participants (n=50) grouped by similar predicted risk. Typically, a 5-pointscoring system is used to grade the degree of liver fibrosis, from F0-F4. Written informed consent was obtained from all participants. 37(2), 558565 (2018). Please enable it to take advantage of the complete set of features! Pract. Int. eCollection 2022. Your FibroScan result will include measurements of the level of steatosis and scarring in your liver. Bookshelf volume13, Articlenumber:3669 (2023) Utaka, S. et al. However, our study has some limitations. CAPis a quantitative surrogate of liver steatosis expressed in decibel per meter (db/m). | Arq Gastroenterol, 2018. /Pattern << Gougeon, R. et al. /CSpg /DeviceGray You can use the following table to look up your livers health. Nutr. 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. Scarring of the liver is measured by four stages. 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. Nutr. To assess the health of your liver, your doctor may recommend a FibroScan test, which is an ultrasound of the liver. Sampath Kumar, A. et al. Circulating levels of endotrophin and cross-linked type III collagen reflect liver fibrosis in people with HIV. Diabetes Care 40(3), 419430 (2017). 2011;141:12491253. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. Nutr. Adv. /F9 9 0 R >> /ColorSpace << Development of alternatives to estimate resting metabolic rate from anthropometric variables in paralympic swimmers. Endocrinol. This means that your actual fibrosis score (the score that your healthcare provider tells you) may not match the fibrosis score in the table. My partner has been diagnosed with cirrhosis and had a second fibro scan on the 02/11 - his previous and first fibroscan KPa result was 29 it has risen to 44.2 in a matter of months - i am not sure what his previous CAP score was - does anyone know what stage of liver disease this is? Conclusions: Liver fat is increased in type 2 diabetic patients and underestimated by serum alanine aminotransferase compared with equally obese nondiabetic subjects. image, Download .pdf (.32 Araiza et al. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). CAS Enhance FibroScan liver disease assessment with biological markers, The non-invasive solution for comprehensive management of liver health, Enhance your FibroScan capabilities for improved management of fatty liver patients, Optimize clinical workflows with real-time secure data transmission. A systematic review of literature. The lower the percentage of your liver with fatty change, the healthier your liver is and the lower your CAP score and steatosis grade from your FibroScan. The cross-sectional design of the current study made it impossible to draw a conclusion on causality. Ultrasound-Based Diagnostic Methods: Possible Use in Fatty Liver Disease Area. It uses ultrasound technology to measure the stiffness of your liver tissue. 2017, 18 (2017). Validation of controlled attenuation parameter measured by fibroscan as a novel surrogate marker for the evaluation of metabolic derangement. eCollection 2022. REE was measured by indirect calorimetry using a Fitmate calorimeter (Cosmed, Italy). Another cross sectional study has also reported no relationship between circulating adiponectin and REE in both young and elderly women after adjusting for several confounding factors such as fat mass and FFM53. Endocrinol. FOIA 2020 Dec;72(6):2228-2230. doi: 10.1002/hep.31498. Our scientists pursue every aspect of cancer researchfrom exploring the biology of genes and cells, to developing immune-based treatments, uncovering the causes of metastasis, and more. Factors related to hypermetabolism in individuals with type 2 diabetes mellitus and non-alcoholic fatty liver disease. Endocrinol. In combination, these scores can help you understand your overall liver health and how it may change over time with lifestyle or medical interventions. doi: 10.1093/crocol/otad004. | Clinical and Translational Gastroenterology, 2016. Tarantino, G., Savastano, S. & Colao, A. Hepatic steatosis, low-grade chronic inflammation and hormone/growth factor/adipokine imbalance. BMC Public Health 18(1), 58 (2017). Obes. (E) French NAFLD cohort (n=182). Systolic and diastolic blood pressure of the participants was measured on the left arm after at least 10min of the seated rest. Rep. 5(6), 513520 (2003). J. Clin. Liver scarring is a serious condition and can lead to life-threatening complications if not addressed. Exp. Advantages of CAP include its ease of measurement, operator-independence and simultaneous availability with LSM for fibrosis assessment. Between September, 2017, and March, 2018, a total of 95 eligible participants (64.40% male) with both T2DM and NAFLD were included, while 32.63% of them were classified as hypermetabolic. The dietary intervention has a positive impact on CAP. Roll-out is further aided by the free availability of the equation, which is also accessible through an app. 11(Suppl), S208S217 (2001). Epub 2011 Sep 15. eCollection 2023. (D) Screen failure rate, missed cases rate, and proportion of patients identified, versus FAST scores values. 2023 Jan 29;15(3):687. doi: 10.3390/nu15030687. livers can have up to 5% of fatty changes in them. Read across the row from left to right until you find the range that includes your fibrosis result. ]RH8zBE%4&7\%jo05$. Publication Arslanow et al. Rodrguez-Iturbe, B. et al. Yanai, H. & Yoshida, H. Beneficical effect of adiponectin on glucose and lipid metabolism and atherosclerothic progression: Mechanisms and perspectives. A score below 238 dB/m means the amount of fatty change in your liver is not higher than normal. A CAP value of 248 dB/m or higher on the FibroScan was diagnosed with fatty liver of any degree 36. 36(3), 358363 (2003). The test can also be used to monitor liver health in patients with a history of alcohol abuse and a family history of liver disease. 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. FibroScan powered by CAP CAP (Controlled Attenuation Parameter) is the non-invasive reference parameter to diagnose and monitor liver steatosis. Normal results are usually between 2 and 7 kPa. Endocrinol. The table below shows liver diseases, ranges of fibrosis results, and the matching fibrosis score. A healthy liver has a CAP score of 5% or lower. 73 to 1 using the dual cutoffs approach, with cutoffs derived in the derivation cohort. endobj The current study suggested that adiponectin was a strong positive determinant for REE in individuals with NAFLD and T2DM. /ExtGState << The FAT in the liver is measured by the Controlled Attenuation Parameter - CAP. Zhou, M. et al. Clin. Clipboard, Search History, and several other advanced features are temporarily unavailable. MS, VM, CF-P, and LS are Echosens employees. FibroScan-aspartate aminotransferase score in an Asian cohort of non-alcoholic fatty liver disease and its utility in predicting histological resolution with bariatric surgery. *CAP is not available on S probe in all countries. 2023 Feb 2;5(1):otad004. Google Scholar. Demographic, anthropometric and biochemical variablesdid not vary significantlyacross two groupsexceptfor total body water, low-density lipoprotein cholesterol and dipeptidyl peptidase 4 (DPP-4) inhibitors (p<0.05). SAH reports grants from Conatus, Immuron, Second Genome, and Tobira/Allergan; grants and personal fees from Axcella, Cirius, CymaBay, Galmed, Gilead, HightTide, Intercept, NGM, Novartis, Novo Nordisk, Pfizer, Galectin, Genfit, and Madrigal; and personal fees from Metacrine, 3V Bio, Albereo, Alexion, Blade Therapeutics, Bristol-Myers Squibb, Civi BioPharma, CLDF, Contravir, Consynance, Concept, Echosens, Gelesis, HistoIndex, Innovate, IQVIA, Medpace, Perspectum, Poxel, Pometheus, Prometic, Terns, Akero, and Lipocine, outside the submitted work. The Controlled Attenuation Parameter (CAP) specifically targets liver steatosis using a process based on transient elastography. Is obesity associated with altered energy expenditure? Normal livers can have up to 5% of fatty changes in them. The formulas used were the HSI (hepatic steatosis index), FLI (fatty liver index), and the NAFLD fibrous score . The multivariate logistic regression test was used for detecting factors associated with hypermetabolism. The AUROCs of the CAP for 5%, >33% and >66% steatosis were 0.79, 0.76 and 0.70, respectively. -, Sanyal AJ. /Producer ( Q t 4 . Prevalence of, MeSH 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. Agarwal, R. Smoking, oxidative stress and inflammation: Impact on resting energy expenditure in diabetic nephropathy. (C) Sensitivity, specificity, positive predictive value, and negative predictive value versus all possible FAST score values. Am. Prevalence of NASH+NAS4+F2=12%. inSite Digestive Health Care, now Genesis Healthcare Partners, an affiliate of Unio Health Partners, offers diagnosis and treatment of diseases of the gastrointestinal system with locations across all of California. PubMed Renal Physiol. Int. An increase in protein turnover has been previously reported in chronic diseases44,45 as well as in diabetes46 and liver disease47. There is a positive association between diabetes and REE15,37. Diagnostics (Basel). J. Diabetes Res. 7(3), 476487 (2016). Strength training increases resting metabolic rate and norepinephrine levels in healthy 50-to 65-yr-old men. Diabetes Res. Plot of the screen failure rate (equal to 1positive predictive value) and missed cases rate (equal to 1sensitivity) versus all possible FAST score values. The spleen-strengthening and liver-draining herbal formula treatment of non-alcoholic fatty liver disease by regulation of intestinal flora in clinical trial. FibroScan is a special ultrasound technology that measures liver stiffness (hardness) and fatty changes in your liver. Transient elastography was performed by one experienced operator, using FibroScan 502 instrument (EchoSense, France, 5 MHz), to detect and quantify liver steatosis (CAP, dB/m) and fibrosis (LSM, kPa). 89(3), 977984 (2000). << The highest possible result is 75 kPa. Determinants of whole-body protein metabolism in subjects with and without type 2 diabetes. FibroScan measures scarring by measuring the stiffness of your liver. No studies have evaluated 24-h urinary sodium excretion and ultrasound or elastography in the same subjects. Animal studies showed that adiponectin administration up-regulates UCP2 expression in the liver tissues of adiponectin knockout mice58,59 and this may increase REE60,61. It shows how much of your liver is affected by fat buildup. Dial. Effects of anti-diabetic treatments in type 2 diabetes and fatty liver disease. The site is secure. Med. Metab. Metab. Syndr. Critical revision, R.J. Acquisition of data, S.M.S.J. (B) Calibration plot and calibration intercept and slope. FAST=FibroScan-aspartate aminotransferase. The last column tells you how much scarring is in your liver. 8(9), 1387 (2019). Published by Elsevier Ltd. Bica, C. et al. Publication Paul et al. Basal metabolic rate in morbidly obese patients with non-alcoholic fatty liver disease. 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. PubMed 26(12), 15471552 (2002). PubMedGoogle Scholar. MathSciNet [2] The table below, adopted from MSK, considers different scores in the context of different liver diseases and can be used to help determine fibrosis score. The .gov means its official. Calibration plots in external validation cohorts (A) French bariatric cohort (n=110). 46(2), 325332 (2022). A fibrosis score of F2 (7.5 to 10 kPa) indicates moderate scarring that has spread outside the liver. pdf files. Diabetes Care 27(10), 24162421 (2004). While the present study found no association between inflammatory markers (CRP and TNF-) and hypermetabolism, the effect of inflammatory markers cannot be completely ruled out; this is because, in this study, we did not examine all inflammatory markers such as IL-6, etc. This is an Open Access article under the CC BY 4.0 license. The CAP was significantly correlated with the percentage of steatosis ( = 0.47) and steatosis grade ( = 0.51; both P < 0.00005). MathSciNet This score will range from 100 dB/m to 400 dB/m. CAP is a guiding point for doctors and patients to improve monitoring of lifestyle change and therapeutic intervention.. CAP is a quantitative surrogate of liver steatosis expressed in decibel per meter (db/m). A significant correlation between BMR and homeostatic model assessment for insulin resistance (HOMA-IR), fasting blood sugar (FBS) and hemoglobin A1c (HbA1c) has been suggested14. (Fatty liver) 3. Then, look at the top of that column to see the fibrosis score. CAS The ultrasound waves move at different speeds through normal liver tissue and areas of fibrosis. 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. See this image and copyright information in PMC. N. Engl. J. Clin. [4] Echosens, FDA Approves FibroScan for Non-invasive Liver Diagnosis, April 2013, https://www.prnewswire.com/news-releases/fda-approves-fibroscan-for-non-invasive-liver-diagnosis-203186961.html#:~:text=%2D%20Echosens%E2%84%A2%20is%20pleased%20to,technology%20in%20the%20United%20States. Methods: >> Taghadomi Masoumi, Z. et al. J. The authors declare no competing interests. In the present study, the CAP values of the 19 NAFLD patients ranged from 248 to 400 dB/m, with . FibroScan is a special ultrasound technology that measures liver stiffness (hardness) and fatty changes in your liver. Controlled attenuation parameter (CAP): a new device for fast evaluation of liver fat? Curr. The discrepancy is mainly driven by the intercept (CIs do not include zero). The French (E) and Turkish (G) NAFLD external validation cohorts are well calibrated; their calibration curve is nearly linear, their intercept is close to zero (CIs include zero), and their slope is close to one (CIs include one). Results of a FibroScan are available immediately following the scan. 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. Accurate tools for the noninvasive detection of hepatic steatosis are needed. Liver congestion (when your liver is too full of blood or other fluids). 15 0 obj Diabetes Care 40, S11S24 (2017). During the procedure, the doctor will place a small probe on your skin. The FibroMeter NAFLD score was determined using a proprietary algorithm (regression score). You are using a browser version with limited support for CSS. The results of the present study showed a positive association between diastolic blood pressure and hypermetabolism. In a future study, recalibration of scores could be considered to correct miscalibration while keeping the same level of discrimination. They are sending me for an MRI with elastography on Friday to confirm the staging. The two biggest risk factors for liver scarring are alcohol abuse and diseases like hepatitis. Most patients with the presence of a metabolic syndrome. Impaired glycemic control and elevated glucose output from the liver due to increased gluconeogenesis and glycogenolysis, which is caused by insulin inefficiency, as well as higher protein turnover, higher sympathetic nervous system activity, oxidative stress, visceral fat and altered body metabolism are potential mechanisms which have been suggested for the increased metabolism in diabetic subjects21,22,23. Article /Type /ExtGState This is usually caused by heart failure. Starling, R. D. Energy expenditure and aging: Effects of physical activity. We have over 20 locations across California, which makes it easy and convenient for our patients to schedule their appointments. Rathaus, M. & Bernheim, J. HHS Vulnerability Disclosure, Help J. Appl. A high performance liquid chromatography analyzer (Tosoh, Japan) was used to measure the levels of HbA1c. Ciardullo, S. & Perseghin, G. Statin use is associated with lower prevalence of advanced liver fibrosis in patients with type 2 diabetes. Expert Rev. CAPis available on the three FibroScan probes (S+*, M+ and XL+). (F) Malaysian NAFLD cohort (n=176). Welle, S. & Nair, K. Relationship of resting metabolic rate to body composition and protein turnover. and JavaScript. Care Med. A CAP score of 5% or lower indicates a healthy liver, while a CAP score of 5% to 33% with a steatosis grade of S1 indicates a mild fatty liver. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Hepatol. CAS Then, look at the top of that column to see the fibrosis score.[3]. 12 0 obj Google Scholar. World J. Gastroenterol. The intercept compares the mean of all predicted risks with the mean observed risk and indicates the extent that predictions are systematically too low or too high. Am. CAP value of 300 falls into S2/S3 stage. Delsoglio, M. et al. 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 than (67%) 318(8), 467472 (1988). Physiol. B. et al. 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. Nutr. Anthropol. Endocrinol. MA reports speaker fees/advisory board fees from MedImmune/Astra Zeneca, E3Bio, and Intercept, outside the submitted work. Some studies suggested that the involvement of adiponectin in energy homeostasis probably mediated through the regulation of uncoupling proteins (UCPs), a family of transporters that present in the mitochondria inner membrane. Hypertens. Huang, Z. et al. Nutrients 11(8), 1830 (2019). 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. Med. In addition, all of these inflammatory markers are checked in the serum of subjects, and it does not necessarily show the inflammatory microenvironment of the liver. By submitting a comment you agree to abide by our Terms and Community Guidelines. Adiponectin acts in the brain to decrease body weight. The Chinese Hong-Kong NAFLD cohort (C) has a zone in which the risk of being NASH+NAS4+F2 is overestimated using the FAST score (grey ribbon below the ideal calibration curve) and a zone in which the calibration seem adequate (grey ribbon zone includes the ideal calibration curve). To use the table, find the liver disease that you have on the left side of the table. 2023 Jan 24;23(1):52. doi: 10.1186/s12879-023-08000-w. Macias J, Parra-Membrives P, Sosa-Moreno F, Rincon P, Martinez-Baena D, Fernandez-Fuertes M, Lorente-Herce JM, Martinez RC, Jimenez-Riera G, Corma-Gomez A, Gonzalez-Serna A, Pineda JA, Real LM. In obese individuals with T2DM, NAFLD, metabolic syndrome and other chronic diseases, increased inflammation and cytokine production, as well as the increased level of reactive oxygen species (ROS) production, play a potential role in increasing BMR, as this process causes mitochondrial disturbance and leads to excess heat generation and a higher level of metabolism17,36. This can be caused by a recent liver illness or drinking alcohol. Fasting hyperglycemia predicts lower rates of weight gain by increased energy expenditure and fat oxidation rate. /PCSp 4 0 R Echosens and UK National Institute for Health Research. PNN and JJD were supported by the NIHR Birmingham BRC. Google Scholar. Do handheld calorimeters have a role in assessment of nutrition needs in hospitalized patients? Mechanisms of altered protein turnover in chronic diseases: A review of human kinetic studies. FAST=FibroScan-aspartate aminotransferase. J. Pediatr. Prevalence of NASH+NAS4+F2=9%. Unauthorized use of these marks is strictly prohibited. Your healthcare provider will use your CAP score to find out your steatosis grade. @Ev*B{p\Qk[Ll0T!]\3# Driving Nonalcoholic Steatohepatitis Forward Using the FibroScan Aspartate Aminotransferase Score, But Obey the Traffic Lights. 2012 Jul;32(6):875-7. doi: 10.1111/j.1478-3231.2012.02824.x. Before 2022 Nov 16;12(11):2822. doi: 10.3390/diagnostics12112822. Accuracy of FibroScan Controlled Attenuation Parameter and Liver Stiffness Measurement in Assessing Steatosis and Fibrosis in Patients With Nonalcoholic Fatty Liver Disease. FibroScan has been in available in the European market since 2003 and was expanded to China, Canada, Brazil, Japan, and many other countries before being approved by the FDA in 2013. CAP provides a convenient and patient-friendly method to assess lipid turnover during lifestyle and dietary interventions to combat NAFLD. 9(1), 2635 (2020). Over 34% but less than 66% is moderate, while over 66% is severe. Work-up for Incidentally Detected NAFLD: How Far is It Worth? There is also evidence showing that resistance training programs increases REE71,72,73,74.