1352-P: Cardiometabolic Risk Factors Superior to FIB4 in Identifying Adults at Risk for NAFLD with Fibrosis

Introduction & Objective: A single effective screening tool for hepatic fibrosis across all age groups is currently lacking. The fibrosis-4 score (FIB-4) is the most commonly used screening tool but is less reliable in younger and older ages. The goal was to identify the best combination of cardiometabolic risk factors in all adults to guide clinical screening for hepatic fibrosis.

Methods: A total of 1420 adults with (63%) and without (37%) type 2 diabetes (T2D) without a prior history of NAFLD were recruited. A complete history, physical examination, and screening for NAFLD with laboratory tests and assessment of insulin sensitivity by HOMA-IR and Adipo-IR were performed. Clinically significant hepatic fibrosis (≥F2) was defined as a liver stiffness measurement ≥8.0 kPa by elastography, or ≥3.0 kPa by MRE, or on liver biopsy.

Results: Of those with hepatic fibrosis (n=135), 34% (n=46) were <35 or >65 years old. The presence of T2D had a sensitivity of 87% and a specificity of 39% for hepatic fibrosis. Adding obesity to T2D, lowered the sensitivity (76%) but increased specificity to 61%. The presence of T2D, obesity, and hypertension (HTN) together did not change test characteristics. Adding atherogenic dyslipidemia (non-HDL ≥130 mg/dL), however, significantly lowered sensitivity (20%). HOMA-IR and Adipo-IR were sensitive but not specific for hepatic fibrosis. The presence of any combination of ≥3 cardiometabolic risk factors (T2D, obesity, HTN, atherogenic dyslipidemia) had a sensitivity of 86% and specificity of 54% for hepatic fibrosis. The addition of FIB-4 ≥1.3 increased the sensitivity to 97% but decreased specificity to 41%. In comparison, FIB-4 ≥1.3 in those 35-65 years old had a sensitivity of 84% and specificity of 25% for hepatic fibrosis.

Conclusion: The presence of ≥3 common cardiometabolic risk factors (T2D, obesity, HTN, atherogenic dyslipidemia) is a simple yet effective clinical screening strategy for NAFLD in all adults with superior specificity compared to FIB-4.