Impact of using different biomarkers of liver fibrosis on hepatologic referral of individuals with severe obesity and NAFLD

PURPOSE

The purpose of this study was to estimate how many individuals with severe obesity and NAFLD should be referred to hepatologists according to the EASL-EASD-EASO guidelines and whether the choice of specific indicators of liver fibrosis would significantly impact the number of referrals.

METHODS

This was a single-center retrospective study of 495 individuals with severe obesity screened at our institution between 2012 and 2018 for a bariatric surgery intervention. The guidelines were applied using the NAFLD Liver Fat Score (NLFS) to assess the presence of steatosis and the NAFLD fibrosis score (NFS), Fibrosis-4 (FIB-4) and Hepamet Fibrosis Score (HFS) to assess the risk of advanced fibrosis.

RESULTS

Three hundred and seventy-nine patients (76.6%) had evidence of liver steatosis. The application of the guidelines would lead to referral of 66.3% of patients using NFS, 31.7% using FIB-4 and 34.2% using HFS. When referrals due to abnormal liver function tests were excluded, these percentages dropped to 55.8%, 7.3% and 12.1%, respectively. The strongest inter-biomarker agreement was found between FIB-4 and HFS (κ = 0.86, 95% CI 0.815-0.910).

CONCLUSION

Strict application of the guidelines in individuals with severe obesity would probably lead to over-referral, although a great variability exists among the different scores.

Resumption of menses after 32 years in anorexia nervosa

In anorexia nervosa estrogen deficient amenorrhea is associated with reduced bone mineral density and increased fracture risk. We report a case of a 53 years old female patient affected with AN since the age of 17 years when also amenorrhea started. During the subsequent 31 years she refused to modify her body weight, she always remained with a BMI below 17, and amenorrhea persisted throughout all the period. In November 2005, when she was 48 years old (BMI 15.6 kg/m²), she came to the Eating Disorder Unit of Niguarda Hospital to treat surgical complication of lower limb wound persisting after two operation; she also presented a marked reduction of bone density. After 6 months of intensive day hospital treatment she got a normal body weight and resumption of menses; in the following four years she has still been well and with normal menses, and bone density showed an improvement.

Laboratory evaluation in patients with anorexia nervosa: usefulness and limits

OBJECTIVE

Eating Disorders (ED), anorexia nervosa (AN) in particular, are significant causes of morbidity and mortality. The purpose of this study is to evaluate how laboratory studies can help to diagnose AN and to choose the type of care according to the degree of medical compromission, particularly in primary care.

PATIENTS AND METHODS

During the years 2002-2009, in our Eating Disorder Centre, we evaluated 298 ED patients diagnosed by criteria Diagnostic and Statistical Manual of Mental Disorders (DMS-IVR) using anthropometric and laboratory tests.

RESULTS

In our 298 ED patients we identified 264 with a BMI value below 17.5 Kg/m(2) (Anorexia Nervosa patients) and 34 subjects with a BMI higher than 17.5 Kg/m(2), but lower than 20 (Eating Disorder Not Otherwise Specified patients). Sixty percent of the subjects showed normal values with respect to the 38 common laboratory tests used in the clinical setting. In the subgroup of AN patients with more severe malnutrition (BMI lower than 14.15 Kg/m(2)), the percentage of abnormal laboratory values was higher, but always below fifty percent; in 19 laboratory test we found a significant correlation between the BMI value and that of the laboratory test.

CONCLUSIONS

The laboratory tests may result as normal even in AN subjects with severe malnutrition and their use without a multi-dimensional evaluation may be misleading, and can even delay the care of patients.