Abstract
PurposeObesity represents a well-known risk factor for metabolic-dysfunction associated fatty liver disease (MAFLD) and its progression towards cirrhosis. The aim of this study is to estimate the proportion of potential candidates to a bariatric surgery intervention that has an elevated liver stiffness on vibration-controlled transient elastography (VCTE).Materials and MethodsThis is a cross-sectional study performed using data obtained during the 2017–2018 cycle of the National Health and Nutrition Examination Survey. Potential candidates for a bariatric surgery intervention from the general US population were identified by applying criteria from international guidelines. All included participants were evaluated by VCTE. A controlled attenuation parameter (CAP) value ≥ 288 dB/m was considered indicative of steatosis while liver stiffness measurement (LSM) was considered elevated if ≥ 9.7 kPa. Multivariable logistic regression models were fitted to identify independent predictors of both outcomes.ResultsA total of 434 participants were included (mean age 42.9 ± 0.6 years; 54.4% women). Among them, 76.7% (95% CI 71.7–81.0) had steatosis, while 23.1% (95% CI 17.8–29.3) had an elevated LSM. Male sex, older age, γ-glutamyltranspeptidase levels, and body mass index (BMI) were independent predictors of steatosis, while BMI was the only independent predictor of elevated LSM. Non-Hispanic black participants were protected from both outcomes, while other ethnicities were not.ConclusionThe prevalence of elevated LSM is high in potential candidates for a bariatric surgery intervention. Accurate screening for occult advanced liver disease might be indicated in this patient population.Graphical abstract
Highlights
Recent data from the National Center for Health statistics (United States) have shown that the age-adjusted prevalence of obesity in adults is steadily growing, affecting 42.4% of US citizens in 2017–2018 as compared with 22.9% in 1988–1994
We report the prevalence of metabolic (dysfunction)-associated fatty liver disease (MAFLD) and elevated liver stiffness measured by vibration-controlled transient elastography (VCTE) in US adults that meet the criteria for a bariatric surgery intervention
The weighted prevalence of steatosis was 76.7%, which was significantly higher than the prevalence of steatosis identified in National Health and Nutrition Evaluation Survey (NHANES) individuals in the same age group that did not meet bariatric surgery criteria (24.4, 95% CI 20.5–28.8, p < 0.001)
Summary
Recent data from the National Center for Health statistics (United States) have shown that the age-adjusted prevalence of obesity in adults is steadily growing, affecting 42.4% of US citizens in 2017–2018 as compared with 22.9% in 1988–1994. The prevalence of severe obesity (defined as a body mass index ≥ 40 kg/m2) more than tripled in the same period (from 2.8 to 9.2%) [1] Fueled by this trend, metabolic (dysfunction)-associated fatty liver disease (MAFLD) has increased in prevalence as well, affecting 37–39% of the general adult US population and ~ 75% of patients with type 2 diabetes (T2D) in the most recent studies [2,3,4]. A seminal study showed that this amount of weight loss could be achieved by only 10% of patients [7] In this context, bariatric surgery, which is the most effective measure to achieve profound and sustained weight loss, represents a valuable tool for the treatment of MAFLD as well, with large reductions in inflammation and fibrosis following different bariatric procedures [8, 9]. Even though different strategies have been adopted to identify patients at high risk of advanced liver disease, including serum biomarkers and imaging techniques [12, 13], most studies reporting the prevalence of advanced fibrosis were performed in single bariatric surgery units and gave largely variable results [14] and population-based studies are lacking
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