Endocrine Abstracts

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease (CLD). Screening of liver fibrosis by clinical scores is recommended in people with obesity, but their accuracy is still under discussion. Vibration-controlled transient elastography (VCTE) is among the best validated imaging tools to assess liver fibrosis, and is suggested in patients with indeterminate or high-risk clinical scores.

Aims: To assess the prevalence of MASLD and significant liver fibrosis in people with obesity, to identify clinical factors associated with fibrosis and to compare the accuracy of the FIB-4 and NFS scores against VCTE.

Methods: Interim analysis from a prospective cohort study conducted on people with a history of class II-III obesity, followed in a tertiary centre. All patients without history of bariatric surgery or significant alcohol intake were invited to undergo VCTE. Patients with other causes of steatosis/CLD were excluded. VCTE fibrosis scores of ≥ F2 (≥ 7kPa) were considered as significant, ≥ F3 as advanced and F4 as cirrhosis.

Results: 33 cases were analyzed, with mean age of 44.1±11.3 years and BMI of 38.9±6.1 kg/m², 69.7% female. MASLD was diagnosed in 81.8%, with significant liver fibrosis in 30.3%, advanced fibrosis in 18.2% and cirrhosis in 6.1%. Aminotransferases were elevated in 27.3%; and aminotransferase elevation was associated with significant liver fibrosis (66.7% vs 16.7%, P=0.010). People with diabetes showed more advanced fibrosis (42.9% vs 11.5%, P=0.093). Fibrosis in VCTE correlated with BMI (r= 0.371, P=0.033), steatosis (r=0.589, P<0.001), triglyceride (r=0.378, P=0.030) and aminotransferase levels (alanine: r=0.442, P=0.010; aspartate: r=0.383, P=0.028). Patients with recent weight loss of ≥10% had less significant liver fibrosis (0.0% vs 38.5%, P=0.073). FIB-4 and NFS showed a specificity of 91.7% and 88.2% for excluding significant fibrosis, but failed to identify any of the cases of significant fibrosis. According to FIB-4, none of the cases with significant fibrosis would have undergone VCTE, whilst according to NFS, 85.7% (53.8% of the cases with an indeterminate score) would have undergone VCTE.

Conclusion: MASLD and liver fibrosis are highly prevalent in people with obesity. Higher BMI, diabetes, elevated aminotransferase and triglyceride levels were associated with increased liver fibrosis, while weight loss of ≥ 10% showed an opposite association. NFS was superior to FIB-4 as an initial screening tool, but both had a low accuracy for identifying significant fibrosis. This suggests that VCTE may have a major role in screening people with obesity and MASLD.