Evaluation of the relationship between serum zinc, copper and ceruloplasmin levels and non-invasive criteria for hepatic fibrosis including FIB-4, NFS and BARD in patients with non-alcoholic fatty liver disease

Abstract

Liver biopsy is not used as a routine screening tool to detect or monitor fibrosis progression in NAFLD due to its invasiveness and cost, and non-invasive methods based on serum biomarkers can be used instead. The aim of this study is the evaluation of the relationship between serum zinc, copper and ceruloplasmin levels and non-invasive criteria for hepatic fibrosis including FIB-4, NFS and BARD in patients with non-alcoholic fatty liver disease. Materials and Methods: This research was a descriptive-analytical cross-sectional study. In this study, the target population was patients with non-alcoholic fatty liver who referred to the gastroenterology clinic of Imam Reza Hospital and Sheikh Al-Raees Clinic of Tabriz in 2022. 134 people were included in the study by random sampling method using a table of random numbers from the list of patients. After giving the necessary explanations and obtaining informed consent, they entered the study. General information and fasting blood samples were taken from patients, and blood levels of zinc, copper, ceruloplasmin, albumin, CBC, fasting blood sugar, and liver enzymes ALT and AST were checked. In this study, non-invasive measures of FIB-4, NFS and BARD were also investigated. Finally, the relationship between the levels of zinc, copper and ceruloplasmin with each of the FIB-4, NFS and BARD criteria was investigated. Results: In this study, the mean (standard deviation) of zinc, copper and ceruloplasmin were 83.84 (±18.7), 110.71 (±25.3) and 36.04 (±12.9), respectively. Also, the mean (SD) of FIB-4 in the studied subjects was 1.06 (±0.6), of which 110 cases (82.1%) were in category one, and 23 cases (17.2%) were in category two and one case (0.7 percent) was in category three. The mean (SD) of NFS in the studied subjects was -1.87 (±1.4), of which 85 cases (63.4%) were in category one, 44 cases (32.8%) were in category two, and 5 cases (3.7%) were in category three. Also, based on the BARD criteria, 25 cases (18.7%) of the studied subjects were in category zero, 39 cases (29.1%) were in category one, 30 cases (22.4%) were in category two, 32 cases (23.9%) were in category three, and 8 cases (6.0%) were in category four. Among serum zinc, copper and ceruloplasmin levels, only zinc serum level was significantly lower in FIB-4 fibrosis score 3 than FIB-4 fibrosis score 1 and 2 (P=0.003); While there was no statistically significant relationship between serum copper and ceruloplasmin variables with FIB-4 fibrosis score in the studied patients (P>0.05). Also, among serum zinc, copper and ceruloplasmin levels, only zinc serum level is significantly higher in NFS fibrosis score 1 than NFS fibrosis scores 2 and 3 (respectively with P=0.002 and P>0.001) and NFS fibrosis score 2 was higher than NFS fibrosis score 3 (P=0.023); While there was no statistically significant relationship between serum copper and ceruloplasmin variables with NFS fibrosis score in the studied patients (P>0.05). Finally, no statistically significant relationship was observed between any of the variables of serum zinc, copper and ceruloplasmin with the BARD fibrosis score in the studied patients (P>0.05).