ArticleBMC gastroenterology2022
Distribution of FIB-4 index in the general population: analysis of 75,666 residents who underwent health checkups.
Article in BMC gastroenterology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers.
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Who cites it
37 citing papers in PubMed, 52 citations in OpenAlex.
- High incidence of advanced liver disease and mortality in patients presenting with alcohol use disorder.Hepatology communications · 2026Article
- Reduced circulating Mig-6 levels are associated with dysglycemia in metabolic dysfunction associated steatotic liver disease (MASLD).BMJ open diabetes research & care · 2026Article
- Hepatic artery augmented velocity index and steatosis/fibrosis in MAFLD.Abdominal radiology (New York) · 2026Article
- Hepatitis E virus infection in a single center in Japan.Clinical and experimental hepatology · 2026Article
- Plasma IGFBP7 improves risk reclassification for liver-related outcomes: Insights from proteo-transcriptomic profiling.JHEP reports : innovation in hepatology · 2026Article
- Development of a machine learning model to identify individuals with VCTE-derived at-risk MASH in a Spanish Mediterranean region.Frontiers in digital health · 2026Article
- Comparison of prevalence of fatty liver disease according to the different nomenclatures of NAFLD, MAFLD, and MASLD in a large Iranian Population-based study.Scientific reports · 2025Article
- A review of multidisciplinary care in metabolic dysfunction-associated steatohepatitis and cardiometabolic disease, with a focus on Canada.Diabetes, obesity & metabolism · 2025Review
- Diagnostic Accuracy of FIB-4 Index and FIB-3 Index for Advanced Fibrosis in Chronic Liver Disease and Age-Specific Thresholds.Journal of clinical medicine · 2025Article
- Comprehensive Evaluation of Non-Standard Inflammatory and Metabolic Indices in Obesity: A Single-Center Retrospective Study.Healthcare (Basel, Switzerland) · 2025Article
- BIGH3 as a potential biomarker for fibrosis in metabolic dysfunction-associated steatotic liver disease: insights from mouse and human studies.BMC gastroenterology · 2025Article
- Usefulness of the Fibrosis-3 index in patients with hepatitis C.Annals of medicine and surgery (2012) · 2025Article
- Considerations and clinical utility of referral pathways for early detection of liver disease in at-risk populations.World journal of gastroenterology · 2025Review
- Response.Canadian family physician Medecin de famille canadien · 2025Article
- Article
- Bidirectional Mendelian randomization analysis and systematic meta-analysis of causal relationships between hepatocellular carcinoma and non-alcoholic fatty liver disease.Discover oncology · 2025Article
- Risk Factors for Type 2 Diabetes Mellitus Relapse in More Than 5-Year Follow-up After Sleeve Gastrectomy with Transit Bipartition.Obesity surgery · 2025Article
- Association of ultrasound signs of sarcopenia with serum ferritin levels and hepatic indices like NFS and FIB-4 in NAFLD patients.BMC gastroenterology · 2025Article
- An investigation of the association between atrial fibrillation and the liver fibrosis-4 index in patients who underwent coronary computed tomography angiography.Hypertension research : official journal of the Japanese Society of Hypertension · 2025Article
- Epidemiology and diagnostic of MASLD in Latin America: a yet to be met challenge.Frontiers in pharmacology · 2025Review
Corrections and comments
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Authors and funding
12 authors at 2 institutions in 3 countries.
Funding
Abstract
backgroundFatty liver is frequently found in a general population, and it is critical to detect advanced fibrosis. FIB-4 index is considered a useful marker for evaluating liver fibrosis but the distribution of FIB-4 index in the general population remains unknown.
methodsThis cross-sectional study included residents who underwent ultrasonography at health checkups in Hiroshima or Iwate prefectures. The distribution of FIB-4 index in the total study population (N = 75,666) as well as in non-alcoholic fatty liver disease (NAFLD) populations (N = 17,968) and non-drinkers without fatty liver populations (N = 47,222) was evaluated. The distribution of aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT) levels was also evaluated.
resultsThe mean FIB-4 index in the total study population was 1.20 ± 0.63. FIB-4 index ≥ 2.67, which indicates a high risk of liver fibrosis, was found in 16.4% of those aged ≥ 70 years. In the NAFLD population, 58.1% of those in their 60 s and 88.1% of those ≥ 70 years met the criteria for referral to hepatologists by using the recommended FIB-4 index cutoff value (≥ 1.3). The mean FIB-4 index in the NAFLD population (1.12 ± 0.58) was significantly lower than in the non-drinkers without fatty liver (1.23 ± 0.63, p < 0.0001). The non-drinkers without fatty liver tended to have higher AST relative to ALT levels (60.0% with AST/ALT > 1.0), whereas the results in the NAFLD population were opposite (14.8% with AST/ALT > 1.0). AST > ALT resulted in a higher FIB-4 index in non-drinkers without fatty liver due to the nature of FIB-4 index formula.
conclusionsThe cutoff value of FIB-4 index (≥ 1.3) for triaging the elderly people with fatty liver for referral to hepatologists should be reconsidered to avoid over-referral. Due to the impact of age and characteristics of AST/ALT ratios, there is no prospect of using FIB-4 index for primary screening for liver fibrosis in a general population of unknown presence or absence of liver disease, even though it can be easily calculated using routine clinical indices. It is desired to develop a non-invasive method for picking up cases with advanced fibrosis latent in the general population.
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