Poster Presentation Australian and New Zealand Obesity Society Annual Scientific Conference 2024

Assessing risk for significant fatty liver disease in a tertiary obesity service (#209)

Victoria Andrews 1 , Janet Franklin 1 2 3 , Elisia Manson 2 , Hannah Nelthorpe 1 2 , Ahmed Bahamdan 2 4 , Georgina Loughnan 2 , Tania Markovic 1 2 5 , Samantha Hocking 1 2 5
  1. Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  2. Metabolism and Obesity Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  3. Translational Health Research Institute, ENRG, Western Sydney University, Sydney, NSW, Australia
  4. Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
  5. Boden Initiative, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia

Background: Up to 90% of patients with obesity have Metabolic Dysfunction Associated Fatty Liver Disease (MAFLD)1. Of these, 40% progress to fibrosis and 5% to cirrhosis2. Assessing the progression of MAFLD is difficult, with liver biopsy remaining the gold standard for identification of fibrosis. Non-invasive scoring systems, including Fibrosis-4 index (FIB-4), NAFLD Fibrosis Score (NFS) and AST to Platelet Ratio Index (APRI) have been developed to identify patients at higher risk of fibrosis. We aimed to assess the utility of these scoring systems in a tertiary obesity service.

 

Methods: Patients attending between 2016-2023 with data to calculate FIB-4, NFS and APRI were included. Patients were categorised as high, intermediate and low risk of significant fibrosis using each scoring system.

 

Results: Included patients (n=529) had mean age 51.5 years, mean BMI 47.1 kg/m2 and 68.4% were female. FIB-4 and APRI scores classified the majority of patients as low risk (76.6% and 89.6%, respectively) and intermediate risk (20.2% and 8.7%, respectively) of fibrosis. In contrast, NFS classified 27.8% as low risk and 45.7% as intermediate risk. Classification of high risk of fibrosis varied with APRI 1.1%, FIB-4 3.2% and NFS 26.5%. For patients with known fibrotic liver disease, FIB-4 identified 40% as low risk, 20% as intermediate and 40% as high risk. APRI identified 50% as low risk, 40% as intermediate and 10% as high risk. NFS identified 30% as intermediate risk and 70% as high risk.

 

Conclusion: NFS most correctly identified patients with known fibrotic liver disease as high risk of fibrosis, however, due to the large number of patients in this cohort classified as intermediate and high-risk, NFS is not feasible as a screening tool in this clinical setting. Further research is required to determine more effective scoring systems to screen for liver fibrosis.

  1. 1. World Health Organisation. Obesity and overweight, https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight#:~:text=Worldwide%20adult%20obesity%20has%20more,16%25%20were%20living%20with%20obesity. (2024, accessed 15/5 2024).
  2. 2. Clark JM. The epidemiology of nonalcoholic fatty liver disease in adults. J Clin Gastroenterol 2006; 40 Suppl 1: S5-10. 2006/03/17. DOI: 10.1097/01.mcg.0000168638.84840.ff.