Endocrine Abstracts

Introduction: Obesity is the primary element of the metabolic syndrome, wherein one of the key reasons that heightens the risk of cardiovascular problems is the presence of liver fibrosis. Invasive core needle biopsy of the liver is considered the definitive method for diagnosing hepatofibrosis, however, non-invasive fibrosis indicators like FIB-4 are becoming more commonly utilized in routine clinical settings. Obesity can be defined in various ways, with the most prevalent methods relying on the measurement of body mass index (BMI) or waist circumference (WC). The aim of the study was to assess which definition of obesity (based on BMI or WC) more effectively indicates an increased risk of liver fibrosis.

Material and methods: The authors analyzed retrospective medical data from 2100 patients who were hospitalized in endocrinology department between 2013 and 2020 in whom all necessary factors were evaluated: weight, height (to calculate BMI), waist circumference, alanine and aspartate aminotransferases and platelet count (to calculate FIB-4 for hepatofibrosis prediction). Obesity was defined in three ways, appropriate to the Caucasian population: WC ≥80 cm (females) or ≥94 cm (males) –criterion A; WC ≥88 cm (females) or ≥ 102 cm (males) –criterion B; BMI ≥30 kg/m² –criterion C. In order to determine suitable thresholds for identifying a higher risk of advanced liver fibrosis authors used cut-offs for age-dependent FIB-4: ≥1.21 for patients up to 49 years of age, ≥1.96 for patients aged 50–59 years and ≥2.67 for patients aged 60–69 years. Evaluation of relative risks (RR) was employed using the Chi-squared test with comparison to patients not meeting a given criterion, each time also providing the 95% confidence interval (95%CI).

Results: Criterion A was met by 82.29% of patients, criterion B was met by 63.52% of patients, and criterion C was met by 42.90% of patients. For criteria A and B, the analysis based on WC revealed statistically insignificant values for the relative risk (P=0.283 for criterion A, P=0.588 for criterion B). Only criterion C, based on BMI, showed a statistically significant increase in relative risk, which was 63% (RR 1.63%; 95%CI: 1.26-2.10; P<0.001).

Conclusion: Body mass index seems to be a better predictor of the risk of advanced liver fibrosis depending on age - patients with obesity defined by this index should be treated as potentially exposed to this complication of the metabolic syndrome and active diagnostics should be undertaken in this direction.