Utility of the Non-Alcoholic Fatty Liver Disease Fibrosis Score in the Eval-uation of Individuals with Medically-Complicated Obesity: A Retrospec-tive Study

Background: Individuals with high body mass index (BMI) are at risk for chronic liver disease. Liver biopsy is a gold standard for the diagnosis of liver disease, as well as for determining the NAFLD activity score and fibrosis stage. Blood alanine aminotransferase (ALT) can support the presence of steatohepatitis, while the non-alcoholic fatty liver disease (NAFLD) fibrosis score (using clinical features and blood testing) may predict fibrosis. Based on prior studies, it is not clear whether the NAFLD fibrosis score is predictive of the NAFLD activity score or fibrosis stage. Aims: The aim was to examine whether clinical features and blood testing can identify the risk of chronic liver disease in those individuals with high BMI. Objective: Individuals with high BMI who may benefit from bariatric surgery were examined for the prevalence of steatohepatitis and for potential relationships between the NAFLD fibrosis score and the NAFLD activity score and fibrosis stage. Methods: This was a retrospective study of 593 consecutive individuals evaluated for bariatric surgery who underwent blood testing. Seventy individuals with a mean BMI of 49.9 kg/m2 un-derwent liver biopsy at surgery. Results: Elevated ALT was present in 102 subjects (17.2%). The correlation coefficient (R: 0.025; p = .83) between the NAFLD fibrosis score and NAFLD activity score was not significant, but there was a weak correlation between the NAFLD fibrosis score and fibrosis stage (R = 0.262; p = .028). Two individuals (3%) had cirrhosis. Conclusion: Elevated ALT may support the presence of liver disease in individuals with high BMI. There is a weak correlation between the NAFLD fibrosis score and the fibrosis stage. Fur-ther work is required to determine whether specific blood and clinical findings can be useful in making clinical decisions with regards to bariatric surgery in those individuals with high BMI.