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Nutrition in acute and chronic diseases

Clinical significance of hepatic fat loss in chronic liver disease: a study using MRI proton density fat fractionation



The liver plays a central role in the fatty acid metabolism. Therefore, cirrhosis is prone to energy malnutrition and is associated with a poor prognosis. On the other hand, proton density fat fraction (PDFF) measured by magnetic resonance imaging (MRI) is a noninvasive and highly accurate method to quantify liver fat. In this study, we aimed to investigate the relationship between hepatic fat loss (HFL) and malnutrition by PDFF measurement in chronic liver disease (CLD).


In this retrospective single-center study of 485 patients with CLD, hepatic fat content was measured by MRI-PDFF, and CT-measured body composition and CONUT (Controlling Nutritional Status) score were used as nutritional assessment methods, respectively.


In the overall cohort, MRI-PDFF was positively correlated with body fat mass, muscle mass and respectively. The HFL defined by PDFF ≤ 2.7% is 25%, and in multivariate analysis, decreased body fat mass and Triglyceride, and increased CONUT score were independent associated factors of HFL (p < 0.05, for all). Additionally, 35% of patients with cirrhosis (n = 107) had HFL, and the Cox proportional hazards model showed that Child–Pugh score and HFL were independent prognostic factors (p < 0.01, for both).


MRI-PDFF was shown to be a useful indicator of malnutrition in cirrhosis reflecting body composition. Preservation of liver fat content in nutritional therapy may improve the prognosis of cirrhotic patients.

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Fig. 1: The relationship of MRI-PDFF between liver pathology and nutritional status in CLD.
Fig. 2: The relationship of MRI-PDFF between severity of liver dysfunction and malnutrition in cirrhosis.

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.


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Authors and Affiliations



Guarantor of the article: AN. Specific author contributions: HA: study concept and design; TY, HA: patient recruitment and characterization; TY: data acquisition, data analysis, and article drafting. All authors provided input and critical revision and approved the final version of the article.

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Correspondence to Atsushi Nakamura.

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Nakamura, A., Yoshimura, T. & Asakura, H. Clinical significance of hepatic fat loss in chronic liver disease: a study using MRI proton density fat fractionation. Eur J Clin Nutr (2022).

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