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Evaluating feasibility and accuracy of non-invasive tests for nonalcoholic fatty liver disease in severe and morbid obesity

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Abstract

Introduction

In obese individuals, nonalcoholic fatty liver disease (NAFLD) is common but often goes undiagnosed, and therefore untreated. The presence of significant fibrosis is a key determinant of NAFLD progression, and liver steatosis has substantial cardiovascular implications. We aimed to determine the diagnostic accuracy of common noninvasive diagnostic tests for steatosis and fibrosis in the obese.

Methods

We recruited 182 severely and morbidly obese individuals undergoing bariatric surgery (age 44 ± 12 years, body mass index 45.1 ± 8.3 kg/m2). Medical history, blood tests and liver biopsy were taken on the day of surgery. Serum steatosis and fibrosis scores were calculated. In a subgroup of patients, transient elastography with controlled attenuation parameter (TE/CAP) (n = 82) and proton magnetic resonance spectroscopy (1H-MRS) (n = 49) were performed.

Results

1H-MRS had excellent diagnostic accuracy for steatosis, with strong correlation to steatosis (r = 0.647, p < 0.001), good AUROC (0.852, p = 0.001), sensitivity (81.3%) and specificity (87.5%). However, due to low feasibility in this cohort (65.3% success), this was substantially decreased with intention-to-diagnose analysis (sensitivity 50.0%, specificity 60.9%). CAP had good feasibility (80.5%), and performed better in intention-to-diagnose analysis (AUROC 0.688, sensitivity 84.8%, specificity 47.2%). Serum steatosis scores performed poorly, with comparable accuracy to ALT. For significant fibrosis, TE had the best accuracy (AUROC 0.903, p = 0.007), which remained reasonable after intention-to-diagnose analysis (sensitivity 100%, specificity 59.0%). A combination approach using CAP with ALT for steatosis and TE with Forn index for fibrosis yielded reasonable overall accuracy.

Conclusions

1H-MRS and TE/CAP had greatest accuracy for NAFLD-related steatosis and fibrosis. Failure rates in obesity significantly diminished diagnostic ability. Use of a combination of serum and imaging tests improved overall feasibility of assessment and diagnostic accuracy in obese individuals.

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Author contributions:

All listed authors have contributed to and agree upon the content of the final manuscript. All authors contributed to study conception, design and data acquisition. GO, PB, NJ and AE performed the data analyses. GO, PB and WB drafted the initial version of the manuscript. All authors critically revised and redrafted the manuscript, and all authors approve the final version.

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Authors and Affiliations

  1. Centre for Obesity Research and Education, Central Clinical School, Monash University, Melbourne, Australia

    Geraldine J. Ooi, Paul R. Burton, Cheryl Laurie & Wendy A. Brown

  2. Department of General Surgery, The Alfred Hospital, Melbourne, Australia

    Geraldine J. Ooi, Paul R. Burton & Wendy A. Brown

  3. Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Clayton, VIC, Australia

    Arul Earnest

  4. Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia

    William W. Kemp, Ammar Majeed & Stuart K. Roberts

  5. Faculty of Health Science, The University of Sydney, Sydney, Australia

    Nathan Johnson

  6. Department of Pathology, The Alfred Hospital, Melbourne, Australia

    Catriona McLean

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  1. Geraldine J. Ooi
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Correspondence to Geraldine J. Ooi.

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Conflict of interest

GO, PB, CL and WB report being affiliated with the Centre for Obesity Research and Education. The Centre has received funding for research purposes from Allergan and Apollo Endosurgery, the manufacturers of the LapBand™. The grant is not tied to any specific research project, and neither Allergan nor Apollo Endosurgery have control of the protocol, analysis and reporting of any studies. The Centre also receives a grant from Applied Medical towards educational programs. WB reports financial support for a bariatric surgery registry from the Commonwealth of Australia, Apollo Endosurgery, Covidien, Johnson and Johnson, Gore and Applied Medical; and a speaker’s honorarium from Merck Sharpe and Dohme. These are outside of the submitted work. NJ reports speaker’s honorarium from Merck Sharpe & Dohme, which is outside of the submitted work. GO reports scholarships from the National Health and Medical Research Council and the Royal Australasian College of Surgeons. WK, AE, AM, CM, SR have no other disclosures or conflicts of interest.

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Ooi, G.J., Earnest, A., Kemp, W.W. et al. Evaluating feasibility and accuracy of non-invasive tests for nonalcoholic fatty liver disease in severe and morbid obesity. Int J Obes 42, 1900–1911 (2018). https://doi.org/10.1038/s41366-018-0007-3

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