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- Title
Nonalcoholic Fatty Liver Disease and Liver Fibrosis in Bariatric Patients: Tehran Obesity Treatment Study (TOTS).
- Authors
Barzin, Maryam; Motamedi, Mohammad Ali Kalantar; Khalaj, Alireza; Serahati, Sara; Khalili, Davood; Morakabati, Arman; Valizadeh, Majid; Azizi, Fereidoun; Hosseinpanah, Farhad; Rakhshani, Nasser
- Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) has become a leading cause of chronic liver disease worldwide. We aimed to study this condition and liver fibrosis in bariatric patients at baseline using ultrasound, NAFLD fibrosis score (NFS), and fibrosis index-4 (FIB-4). Methods: Adult patients with morbid obesity without other possible causes of liver pathology were evaluated. Liver biopsy was performed in a subset of patients. Diagnostic accuracy of tests was assessed using area under the receiver operating-characteristic curve (AUROC). Results: Overall, 1944 patients with mean age of 38.3 - 10.8 years and body mass index of 44.6 - 6.4 kg/m² comprised the study population. Liver Biopsyshowed features of NAFLDin 70%; 60.3% hadnonalcoholic fatty liver and9.6% steatohepatitis. Older age and higher transaminase levels were associated with higher NAFLD activity score. Fibrosis was present in 23.3% with the majority having F1. Ultrasound detected steatosis in 76.8%, with two-thirds having grade I to II fatty liver. Metabolic syndrome, hemoglobin A1c, age, and alanine transaminase were the strongest risk factors for fatty liver. Ultrasound showed an AUROC of 0.75 (95% confidence interval 0.63-0.86) for NAFLD with a sensitivity and specificity of 72.5% and 68.2%, respectively (cutoff of grade II). For diagnosis of fibrosis, FIB-4 had an AUROC of 0.72 (0.58-0.86) with 93.3% sensitivity and 43.1% specificity (cutoff of 0.50). NFS failed to show a significant AUROC curve for diagnosing fibrosis. Conclusions: Our findings confirmed a high prevalence of NAFLD in morbidly obese patients. Despite this high prevalence, fibrosis was uncommon and low-grade. This study questions the use of current cutoffs for NFS and FIB-4 in all patients.
- Subjects
IRAN; BIOPSY; CONFIDENCE intervals; FATTY liver; LIVER; CIRRHOSIS of the liver; BARIATRIC surgery; OVERWEIGHT persons; MORBID obesity; DISEASE complications; DISEASE risk factors
- Publication
Hepatitis Monthly, 2018, Vol 18, Issue 5, p1
- ISSN
1735-143X
- Publication type
Article
- DOI
10.5812/hepatmon.64380