ArticleThe Journal of clinical endocrinology and metabolism2022
Obesity Modifies the Performance of Fibrosis Biomarkers in Nonalcoholic Fatty Liver Disease.
Article in The Journal of clinical endocrinology and metabolism, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
33 citing papers in PubMed, 56 citations in OpenAlex.
- A Two-Step Algorithm for the Noninvasive Identification of Candidates for Nonalcoholic Steatohepatitis Clinical Trials: The APRI-FAST.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2023Trial
- Discordance between adiposity and FIB-4 risk classification in US adults.Journal of diabetes and metabolic disorders · 2026Article
- Screening and diagnosis of liver disease in diabetes: a guide and evidence-based assessment.Diabetologia · 2026Review
- Derivation and internal validation of the enhanced liver fibrosis (ELF)-based prediction score for advanced liver fibrosis in obese patients undergoing bariatric surgery.Surgical endoscopy · 2026Article
- Consensus statement on obesity management in liver transplantation candidates.Updates in surgery · 2026Article
- Risk assessment in metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction and alcohol-related liver disease: current approaches and future directions.Clinical and molecular hepatology · 2026Review
- Interplay between MASLD, obesity and type 2 diabetes: epidemiology, shared pathways and clinical implications.BMJ open gastroenterology · 2026Review
- Diabetes and obesity reduce FIB-4 accuracy in MASLD referral pathways.JHEP reports : innovation in hepatology · 2026Article
- Key Measures for Evaluating Diagnostic Accuracy in Multi-Class Classification: An Overview and Simulation-Based Comparison.Korean journal of radiology · 2026Review
- 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes-2026.Diabetes care · 2026Review
- Evaluation of Fibrosis-4 Index, nonalcoholic fatty liver disease fibrosis score, and aspartate aminotransferase-to-platelet ratio index as noninvasive indicators of fibrosis in patients with nonalcoholic fatty liver disease.Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences · 2026Article
- Clinical trial design, biomarkers and end points in metabolic and alcohol-related liver disease.Nature reviews. Gastroenterology & hepatology · 2025Review
- Prospective, Matched Case-Control Study of Endoscopic Sleeve Gastroplasty and Semaglutide in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease at One Year.Digestive diseases and sciences · 2025Article
- Reduced Predictive Performance of the FIB-4 Index in Chronic Hepatitis B Patients With Concurrent Metabolic Dysfunction-Associated Liver Disease.Journal of viral hepatitis · 2025Article
- Comparing FIB-4, VCTE, pSWE, 2D-SWE, and MRE Thresholds and Diagnostic Accuracies for Detecting Hepatic Fibrosis in Patients with MASLD: A Systematic Review and Meta-Analysis.Diagnostics (Basel, Switzerland) · 2025Review
- The Use of Non-i nvasive Biomarkers to Screen for Advanced Fibrosis Associated with Metabolic Dysfunction-associated Steatotic Liver Disease in People with Type 2 Diabetes: A Narrative Review.TouchREVIEWS in endocrinology · 2025Review
- Non-invasive liver fibrosis markers are increased in obese individuals with non-alcoholic fatty liver disease and the metabolic syndrome.Scientific reports · 2025Article
- Precision in Liver Diagnosis: Varied Accuracy Across Subgroups and the Need for Variable Thresholds in Diagnosis of MASLD.Liver international : official journal of the International Association for the Study of the Liver · 2025Article
- 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes-2025.Diabetes care · 2025Review
- Modified FIB-4 Index in Type 2 Diabetes Mellitus with Steatosis: A Non-Linear Predictive Model for Advanced Hepatic Fibrosis.Diagnostics (Basel, Switzerland) · 2024Article
Corrections and comments
- Commented on by
Authors and funding
21 authors at 7 institutions in 5 countries.
Funding
Abstract
contextGuidelines recommend blood-based fibrosis biomarkers to identify advanced nonalcoholic fatty liver disease (NAFLD), which is particularly prevalent in patients with obesity.
objectiveTo study whether the degree of obesity affects the performance of liver fibrosis biomarkers in NAFLD.
designCross-sectional cohort study comparing simple fibrosis scores [Fibrosis-4 Index (FIB-4); NAFLD Fibrosis Score (NFS); aspartate aminotransferase to platelet ratio index; BARD (body mass index, aspartate-to-alanine aminotransferase ratio, diabetes); Hepamet Fibrosis Score (HFS)] and newer scores incorporating neo-epitope biomarkers PRO-C3 (ADAPT, FIBC3) or cytokeratin 18 (MACK-3).
settingTertiary referral center. PATIENTS: We recruited overweight/obese patients from endocrinology (n = 307) and hepatology (n = 71) clinics undergoing a liver biopsy [median body mass index (BMI) 40.3 (interquartile range 36.0-44.7) kg/m2]. Additionally, we studied 859 less obese patients with biopsy-proven NAFLD to derive BMI-adjusted cutoffs for NFS.
main outcome measuresBiomarker area under the receiver operating characteristic (AUROC), sensitivity, specificity, and predictive values to identify histological stage ≥F3 fibrosis or nonalcoholic steatohepatitis with ≥F2 fibrosis [fibrotic nonalcoholic steatohepatitis (NASH)].
resultsThe scores with an AUROC ≥0.85 to identify ≥F3 fibrosis were ADAPT, FIB-4, FIBC3, and HFS. For fibrotic NASH, the best predictors were MACK-3 and ADAPT. The specificities of NFS, BARD, and FIBC3 deteriorated as a function of BMI. We derived and validated new cutoffs for NFS to rule in/out ≥F3 fibrosis in groups with BMIs <30.0, 30.0 to 39.9, and ≥40.0 kg/m2. This optimized its performance at all levels of BMI. Sequentially combining FIB-4 with ADAPT or FIBC3 increased specificity to diagnose ≥F3 fibrosis.
conclusionsIn obese patients, the best-performing fibrosis biomarkers are ADAPT and the inexpensive FIB-4, which are unaffected by BMI. The widely used NFS loses specificity in obese individuals, which may be corrected with BMI-adjusted cutoffs.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.