Diabetologia

, Volume 60, Issue 7, pp 1218–1222

EASL–EASD–EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease in severely obese people: do they lead to over-referral?

  • Emilie Blond
  • Emmanuel Disse
  • Charlotte Cuerq
  • Jocelyne Drai
  • Pierre-Jean Valette
  • Martine Laville
  • Charles Thivolet
  • Chantal Simon
  • Cyrielle Caussy
Short Communication

DOI: 10.1007/s00125-017-4264-9

Cite this article as:
Blond, E., Disse, E., Cuerq, C. et al. Diabetologia (2017) 60: 1218. doi:10.1007/s00125-017-4264-9

Abstract

Aims/hypothesis

We aimed to assess the application of the recent European Association for the Study of the Liver (EASL)–European Association for the Study of Diabetes (EASD)–European Association for the Study of Obesity (EASO) clinical practice guidelines for the management of non-alcoholic fatty liver disease (NAFLD) in severely obese individuals in routine clinical practice.

Methods

We performed a single-centre retrospective observational study of 385 patients referred for severe obesity (BMI ≥ 35 kg/m2) to our Endocrinology, Diabetes and Nutrition department, between 1 November 2014 and 31 December 2015. The recent EASL–EASD–EASO clinical practice guidelines for the management of NAFLD were retrospectively applied to the cohort using, successively, the NAFLD fibrosis score (NFS) and a combination of the NFS and transient elastography (TE) measurement in a subgroup of individuals.

Results

We identified 313 (81.3%) individuals with NAFLD in the cohort. The application of the EASL–EASD–EASO guidelines using NFS would lead to referral to a specialist for up to 289 individuals (75.1%) in the cohort. The combination of NFS and TE measurement reclassified 28 (25%) individuals from the medium/high risk group to low risk and would lead to the referral of 261 (67.7%) individuals to a specialist. These proportions appear to be excessive given the expected prevalence of advanced fibrosis and non-alcoholic steatohepatitis (NASH) of around 10% and 30%, respectively, in the severely obese population.

Conclusions/interpretation

This is the first study to assess the strategy proposed by the EASL–EASD–EASO clinical practice guidelines for the management of NAFLD in severely obese individuals. The retrospective application of the guidelines in a cohort representing the routine clinical practice in our department would lead to an excessive number of specialist referrals and would also lead to an unjustified increase in health costs. Biomarkers and specific strategy for the screening of NASH and advanced fibrosis in morbidly obese individuals are thus crucially needed and would help to improve the actual guidelines.

Keywords

Fibrosis NAFLD fibrosis score Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Obesity Transient elastography 

Abbreviations

ALT

Alanine transaminase

AST

Aspartate aminotransferase

EASL

European Association for the Study of the Liver

EASO

European Association for the Study of Obesity

GGT

γ-Glutamyltransferase

NAFLD

Non-alcoholic fatty liver disease

NASH

Non-alcoholic steatohepatitis

NFS

NAFLD fibrosis score

SWE

Shear wave elastography

TE

Transient elastography

Supplementary material

125_2017_4264_MOESM1_ESM.pdf (52 kb)
ESM Table 1(PDF 51 kb)

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Emilie Blond
    • 1
  • Emmanuel Disse
    • 2
    • 3
  • Charlotte Cuerq
    • 1
  • Jocelyne Drai
    • 1
  • Pierre-Jean Valette
    • 4
  • Martine Laville
    • 2
    • 3
  • Charles Thivolet
    • 2
    • 3
  • Chantal Simon
    • 2
    • 3
  • Cyrielle Caussy
    • 2
    • 3
  1. 1.Biochemistry DepartmentLyon Sud Hospital, Hospices Civils de Lyon, Claude-Bernard Lyon 1 UniversityPierre BéniteFrance
  2. 2.Department of Endocrinologie, Diabète, Nutrition, Centre Intégré de l’Obésité Rhône-Alpes, Fédération Hospitalo-Universitaire DO-iT, Lyon Sud Hospital, Hospices Civils de Lyon, Claude-Bernard Lyon 1 UniversityPierre-Bénite CedexFrance
  3. 3.Laboratoire CarMeN, Unité Inserm U1060 - INRA 1235 - INSA-LyonPierre BéniteFrance
  4. 4.Department of RadiologyE. Herriot University Hospital, Hospices Civils de Lyon, Claude-Bernard Lyon 1 UniversityLyonFrance

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