Background and Aims: Non-alcoholic fatty liver disease (NAFLD) is prevalent in obese and type 2 diabetes mellitus (T2DM) patients (1-3). NAFLD can progress to cirrhosis and hepatocellular cancer. Predicting disease progression may help select patients for liver biopsy. The Enhanced Liver Fibrosis (ELF) score is calculated from 3 serum markers (tissue inhibitor of metalloproteinases 1, amino-terminal propeptide of type III procollagen and hyaluronic acid), and correlates well with fibrosis in chronic hepatitis population (4,5). Because its performance in the general population of obese people is poorly understood, we determined if ELF score could predict liver fibrosis in obese patients having gastric banding surgery.
Methods: Liver biopsies, clinical and biochemical characteristics of 82 obese people were obtained. Liver fibrosis was determined by histological score and ELF score was determined using fasting serum.
Results: In this cohort (F:M ratio 57:25; age: 46 ± 11 years; BMI: 43 ± 6 kg/m2), 34% had T2DM, 71% had dyslipidaemia and 82% had hypertension. Severe steatosis on biopsy (score 3 and 4) was present in 66% of the entire cohort, and in 71% of T2DM subgroup. Thirty patients (37%) were found to have steatosis and inflammation on biopsy, and three of these had severe fibrosis. Diabetes status and inflammation on biopsy were associated with fibrosis (p< 0.001). An ELF score of <7.7 excluded all cases of moderate/ severe fibrosis, but higher ELF scores were not specific for fibrosis.
Conclusion: In an unselected cohort of obese patients undergoing bariatric surgery, liver steatosis was present in 71% of the diabetic subjects. Diabetes status was associated with fibrosis. A low ELF score excluded all subjects with significant fibrosis. The non-specificity of elevated ELF score in obese subjects might be due to elevated collagen markers such as hyaluronic acid from co-existing osteoarthritis.