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Ooi GJ, Mgaieth S, Eslick GD, Burton PR, Kemp WW, Roberts SK, Brown WA. Systematic review and meta-analysis: non-invasive detection of non-alcoholic fatty liver disease related fibrosis in the obese. Obes Rev 2018; 19:281-294. [PMID: 29119725 DOI: 10.1111/obr.12628] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/11/2017] [Accepted: 09/15/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a significant disease burden in obesity. Liver fibrosis is an important prognostic factor in NAFLD, and detection is vital. The pathophysiological changes of obesity can alter the accuracy of non-invasive NAFLD tests. We aimed to review current evidence for common non-invasive tests for NAFLD-related fibrosis in obesity. METHODS We systematically searched for studies assessing the diagnostic accuracy of 11 biomarker panels and elastography techniques for NAFLD-related fibrosis in obesity. Meta-analyses were performed where possible. RESULTS Thirty-eight studies were identified assessing the selected tests in obese populations. Simple biomarker panels (e.g. NAFLD fibrosis score) were the most validated. Evidence showed better accuracy of complex biomarker panels (NAFLD fibrosis score: summary receiver operator characteristic [SROC] 0.795-0.813 vs. enhanced liver fibrosis: SROC 0.962); however, these were poorly validated in obesity. Elastography techniques were better studied and had high diagnostic accuracy (transient elastography: SROC 0.859; magnetic resonance elastography: SROC 0.965) but were limited by BMI-dependent failure. Limited evidence was found to validate the accuracy of any test in exclusively obese populations. CONCLUSION In obese subjects, complex biomarker panels and elastography have been reasonable to good accuracy for NAFLD-related fibrosis; however, these methods have not been well validated. Further study in this high-risk population is needed.
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Affiliation(s)
- G J Ooi
- Centre for Obesity Research and Education, Monash University, Melbourne, Australia.,Department of Surgery, The Alfred Hospital, Melbourne, Australia
| | - S Mgaieth
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia.,Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
| | - G D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, Australia
| | - P R Burton
- Centre for Obesity Research and Education, Monash University, Melbourne, Australia.,Department of Surgery, The Alfred Hospital, Melbourne, Australia
| | - W W Kemp
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia
| | - S K Roberts
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia
| | - W A Brown
- Centre for Obesity Research and Education, Monash University, Melbourne, Australia.,Department of Surgery, The Alfred Hospital, Melbourne, Australia
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Ooi GJ, Doyle L, Tie T, Wentworth JM, Laurie C, Earnest A, Cowley MA, Sikaris K, le Roux CW, Burton PR, O'Brien PE, Brown WA. Weight loss after laparoscopic adjustable gastric band and resolution of the metabolic syndrome and its components. Int J Obes (Lond) 2017; 41:902-908. [PMID: 28262677 DOI: 10.1038/ijo.2017.59] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 02/11/2017] [Accepted: 02/19/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Substantial weight loss in the setting of obesity has considerable metabolic benefits. Yet some studies have shown improvements in obesity-related metabolic comorbidities with more modest weight loss. By closely monitoring patients undergoing bariatric surgery, we aimed to determine the effects of weight loss on the metabolic syndrome and its components and determine the weight loss required for their resolution. METHODS We performed a prospective observational study of obese participants with metabolic syndrome (Adult Treatment Panel III criteria) who underwent laparoscopic adjustable gastric banding. Participants were assessed for all criteria of the metabolic syndrome monthly for the first 9 months, then 3-monthly until 24 months. RESULTS There were 89 participants with adequate longitudinal data. Baseline body mass index was 42.4±6.2 kg m-2 with an average age was 48.2±10.7 years. There were 56 (63%) women. Resolution of the metabolic syndrome occurred in 60 of the 89 participants (67%) at 12 months and 60 of the 75 participants (80%) at 24 months. The mean weight loss when metabolic syndrome resolved was 10.9±7.7% total body weight loss (TBWL). The median weight loss at which prevalence of disease halved was 7.0% TBWL (17.5% excess weight loss (EWL)) for hypertriglyceridaemia; 11% TBWL (26.1-28% EWL) for high-density lipoprotein cholesterol and hyperglycaemia; 20% TBWL (59.5% EWL) for hypertension and 29% TBWL (73.3% EWL) for waist circumference. The odds ratio for resolution of the metabolic syndrome with 10-12.5% TBWL was 2.09 (P=0.025), with increasing probability of resolution with more substantial weight loss. CONCLUSIONS In obese participants with metabolic syndrome, a weight loss target of 10-12.5% TBWL (25-30% EWL) is a reasonable initial goal associated with significant odds of having metabolic benefits. If minimal improvements are seen with this initial target, additional weight loss substantially increases the probability of resolution.
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Affiliation(s)
- G J Ooi
- Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia.,Monash University Department of Surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | - L Doyle
- Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia
| | - T Tie
- Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia.,Monash University Department of Surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | - J M Wentworth
- Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia.,Walter and Eliza Hall Institute, Melbourne University, Parkville, Victoria, Australia
| | - C Laurie
- Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia
| | - A Earnest
- Department of Epidemiology, SPHPM, Monash University, Melbourne, Victoria, Australia
| | - M A Cowley
- MODI, Monash University, Melbourne, Victoria, Australia
| | - K Sikaris
- Melbourne Pathology, East Melbourne, Victoria, Australia
| | - C W le Roux
- Diabetes Complications Research Centre, University College, Dublin, Ireland
| | - P R Burton
- Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia
| | - P E O'Brien
- Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia
| | - W A Brown
- Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia.,Monash University Department of Surgery, Alfred Hospital, Melbourne, Victoria, Australia
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