Obesity Surgery

, Volume 18, Issue 3, pp 264–270 | Cite as

The Utility of the “NAFLD Fibrosis Score” in Morbidly Obese Subjects with NAFLD

  • Kamran Qureshi
  • Ronald H. Clements
  • Gary A. AbramsEmail author
Research Article



To date, the noninvasive diagnostic tests for hepatic fibrosis in subjects with nonalcoholic fatty liver disease (NAFLD) have proven to be suboptimal. We evaluated the validity of a recently proposed “NAFLD fibrosis score” to identify liver fibrosis in morbidly obese individuals with elevated and normal alanine aminotransferase (ALT) levels.


Medical records of 401 patients that underwent a gastric bypass operation and intraoperative liver biopsy were analyzed. Three hundred thirty one patients with biopsy-proven NAFLD were included in the study (group A). These patients were divided into two ALT groups based on their levels according to the new proposed normal range: group B elevated level (ALT > 19 U/L in females and >30 U/L in males, n = 221) and group C normal ALT (n = 110). Diagnostic accuracy of the system was assessed for the presence/absence of any fibrosis, significant fibrosis (stage 2–4), and advanced fibrosis (stages 3 and 4) in all of the groups.


The prevalence of advanced fibrosis in our cohort was about 14%. The low NAFLD fibrosis score demonstrated high accuracy for ruling out advanced fibrosis, with negative predictive value (NPV) of 98 and 99% in groups A and B, respectively. The NPV for significant fibrosis in groups A, B, and C was 87, 88, and 88%, respectively. The respective positive predictive value for the high NAFLD fibrosis score for the presence of any fibrosis was 88, 95, and 77% in groups A, B, and C.


The NAFLD fibrosis score may be a useful noninvasive approach for excluding significant and advanced fibrosis and in morbidly obese patients.


Nonalcoholic fatty liver disease Noninvasive diagnostic test NAFLD fibrosis score 


  1. 1.
    Bedogni G, Miglioli L, Masutti F, Tiribelli C, Marchesini G, Bellentani S. Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study. Hepatology 2005;42:44–52.PubMedCrossRefGoogle Scholar
  2. 2.
    Gholam P, Kotler D, Flancbaum L. Liver pathology in morbidly obese patients undergoing Roux-en-Y gastric bypass surgery. Obes Surg. 2002;12:49–51.PubMedCrossRefGoogle Scholar
  3. 3.
    Ong J, Elariny H, Collantes R, Younoszai A, Chandhoke V, Reines H, et al. Predictors of nonalcoholic steatohepatitis and advanced fibrosis in morbidly obese patients. Obes Surg. 2005;15:310–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94:2467–74.PubMedCrossRefGoogle Scholar
  5. 5.
    Ratziu V, Charlotte F, Heurtier A, Gombert S, Giral P, Bruckert E, et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology 2005;128:1898–906.PubMedCrossRefGoogle Scholar
  6. 6.
    Ratziu V, Massard J, Charlotte F, Messous D, Imbert-Bismut F, Bonyhay L, et al. Diagnostic value of biochemical markers (FibroTest-FibroSURE) for the prediction of liver fibrosis in patients with non-alcoholic fatty liver disease. BMC Gastroenterol. 2006;6:6.PubMedCrossRefGoogle Scholar
  7. 7.
    Angulo P, Hui J, Marchesini G, Bugianesi E, George J, Farrell G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology 2007;45:846–54.PubMedCrossRefGoogle Scholar
  8. 8.
    Mofrad P, Contos M, Haque M, Sargeant C, Fisher R, Luketic V, et al. Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values. Hepatology 2003;37:1286–92.PubMedCrossRefGoogle Scholar
  9. 9.
    Prati D, Taioli E, Zanella A, Della Torre E, Butelli S, Del Vecchio E, et al. Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med. 2002;137:1–10.PubMedGoogle Scholar
  10. 10.
    Kunde SS, Lazenby AJ, Clements RH, Abrams GA. Spectrum of NAFLD and diagnostic implications of the proposed new normal range for serum ALT in obese women. Hepatology 2005;42:650–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41:1313–21.PubMedCrossRefGoogle Scholar
  12. 12.
    Ratziu V, Giral P, Charlotte F, Bruckert E, Thibault V, Theodorou I, et al. Liver fibrosis in overweight patients. Gastroenterology 2000;118:1117–23.PubMedCrossRefGoogle Scholar
  13. 13.
    Abrams G, Kunde S, Lazenby A, Clements R. Portal fibrosis and hepatic steatosis in morbidly obese subjects: a spectrum of nonalcoholic fatty liver disease. Hepatology 2004;40:475–83.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Kamran Qureshi
    • 1
  • Ronald H. Clements
    • 2
  • Gary A. Abrams
    • 3
    Email author
  1. 1.Department of PathologyUniversity of AlabamaBirminghamUSA
  2. 2.Department of SurgeryUniversity of AlabamaBirminghamUSA
  3. 3.Department of Medicine, UAB Health Center MontgomeryUniversity of AlabamaMontgomeryUSA

Personalised recommendations