Obesity Modifies the Performance of Fibrosis Biomarkers in Nonalcoholic Fatty Liver Disease
Guidelines recommend blood-based fibrosis biomarkers to identify advanced nonalcoholic fatty liver disease (NAFLD), which is particularly prevalent in patients with obesity. To study whether the degree of obesity affects the performance of liver fibrosis biomarkers in NAFLD. Cross-sectional cohort s...
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| Veröffentlicht in: | The journal of clinical endocrinology and metabolism 2022-04, Vol.107 (5), p.e2008-e2020 |
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| creator | Qadri, Sami Ahlholm, Noora Lønsmann, Ida Pellegrini, Paola Poikola, Anni Luukkonen, Panu K Porthan, Kimmo Juuti, Anne Sammalkorpi, Henna Penttilä, Anne K D'Ambrosio, Roberta Soardo, Giorgio Leeming, Diana J Karsdal, Morten Arola, Johanna Kechagias, Stergios Pelusi, Serena Ekstedt, Mattias Valenti, Luca Hagström, Hannes Yki-Järvinen, Hannele |
| description | Guidelines recommend blood-based fibrosis biomarkers to identify advanced nonalcoholic fatty liver disease (NAFLD), which is particularly prevalent in patients with obesity.
To study whether the degree of obesity affects the performance of liver fibrosis biomarkers in NAFLD.
Cross-sectional cohort study comparing simple fibrosis scores [Fibrosis-4 Index (FIB-4); NAFLD Fibrosis Score (NFS); aspartate aminotransferase to platelet ratio index; BARD (body mass index, aspartate-to-alanine aminotransferase ratio, diabetes); Hepamet Fibrosis Score (HFS)] and newer scores incorporating neo-epitope biomarkers PRO-C3 (ADAPT, FIBC3) or cytokeratin 18 (MACK-3).
Tertiary referral center.
We recruited overweight/obese patients from endocrinology (n = 307) and hepatology (n = 71) clinics undergoing a liver biopsy [median body mass index (BMI) 40.3 (interquartile range 36.0-44.7) kg/m2]. Additionally, we studied 859 less obese patients with biopsy-proven NAFLD to derive BMI-adjusted cutoffs for NFS.
Biomarker area under the receiver operating characteristic (AUROC), sensitivity, specificity, and predictive values to identify histological stage ≥F3 fibrosis or nonalcoholic steatohepatitis with ≥F2 fibrosis [fibrotic nonalcoholic steatohepatitis (NASH)].
The scores with an AUROC ≥0.85 to identify ≥F3 fibrosis were ADAPT, FIB-4, FIBC3, and HFS. For fibrotic NASH, the best predictors were MACK-3 and ADAPT. The specificities of NFS, BARD, and FIBC3 deteriorated as a function of BMI. We derived and validated new cutoffs for NFS to rule in/out ≥F3 fibrosis in groups with BMIs |
| doi_str_mv | 10.1210/clinem/dgab933 |
| format | Article |
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To study whether the degree of obesity affects the performance of liver fibrosis biomarkers in NAFLD.
Cross-sectional cohort study comparing simple fibrosis scores [Fibrosis-4 Index (FIB-4); NAFLD Fibrosis Score (NFS); aspartate aminotransferase to platelet ratio index; BARD (body mass index, aspartate-to-alanine aminotransferase ratio, diabetes); Hepamet Fibrosis Score (HFS)] and newer scores incorporating neo-epitope biomarkers PRO-C3 (ADAPT, FIBC3) or cytokeratin 18 (MACK-3).
Tertiary referral center.
We recruited overweight/obese patients from endocrinology (n = 307) and hepatology (n = 71) clinics undergoing a liver biopsy [median body mass index (BMI) 40.3 (interquartile range 36.0-44.7) kg/m2]. Additionally, we studied 859 less obese patients with biopsy-proven NAFLD to derive BMI-adjusted cutoffs for NFS.
Biomarker area under the receiver operating characteristic (AUROC), sensitivity, specificity, and predictive values to identify histological stage ≥F3 fibrosis or nonalcoholic steatohepatitis with ≥F2 fibrosis [fibrotic nonalcoholic steatohepatitis (NASH)].
The scores with an AUROC ≥0.85 to identify ≥F3 fibrosis were ADAPT, FIB-4, FIBC3, and HFS. For fibrotic NASH, the best predictors were MACK-3 and ADAPT. The specificities of NFS, BARD, and FIBC3 deteriorated as a function of BMI. We derived and validated new cutoffs for NFS to rule in/out ≥F3 fibrosis in groups with BMIs <30.0, 30.0 to 39.9, and ≥40.0 kg/m2. This optimized its performance at all levels of BMI. Sequentially combining FIB-4 with ADAPT or FIBC3 increased specificity to diagnose ≥F3 fibrosis.
In obese patients, the best-performing fibrosis biomarkers are ADAPT and the inexpensive FIB-4, which are unaffected by BMI. The widely used NFS loses specificity in obese individuals, which may be corrected with BMI-adjusted cutoffs.</description><identifier>ISSN: 0021-972X</identifier><identifier>ISSN: 1945-7197</identifier><identifier>EISSN: 1945-7197</identifier><identifier>DOI: 10.1210/clinem/dgab933</identifier><identifier>PMID: 34971370</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Antigenic determinants ; Aspartate ; Aspartate Aminotransferases ; Biological markers ; Biomarkers ; Biopsy ; Body mass index ; Cross-Sectional Studies ; Fatty liver ; Fibrosis ; Humans ; Keratin ; Liver - pathology ; Liver cirrhosis ; Liver Cirrhosis - diagnosis ; Liver Cirrhosis - etiology ; Liver Cirrhosis - pathology ; Medical research ; Medicine, Experimental ; Non-alcoholic Fatty Liver Disease - complications ; Non-alcoholic Fatty Liver Disease - diagnosis ; Non-alcoholic Fatty Liver Disease - pathology ; Obesity ; Obesity - complications ; Obesity - pathology ; Online Only ; Type 2 diabetes</subject><ispartof>The journal of clinical endocrinology and metabolism, 2022-04, Vol.107 (5), p.e2008-e2020</ispartof><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society.</rights><rights>COPYRIGHT 2022 Oxford University Press</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c599t-e1ff2f44f8473ca2dc2a3b5e0168806576c8c65b9b2e1d906fbe9055f8aa9abc3</citedby><cites>FETCH-LOGICAL-c599t-e1ff2f44f8473ca2dc2a3b5e0168806576c8c65b9b2e1d906fbe9055f8aa9abc3</cites><orcidid>0000-0003-3181-5651 ; 0000-0003-3865-5507 ; 0000-0001-7614-739X ; 0000-0002-8474-1759 ; 0000-0002-4256-140X ; 0000-0001-7480-8959 ; 0000-0001-8909-0345 ; 0000-0001-6766-1549 ; 0000-0003-2085-679X ; 0000-0001-9313-9324 ; 0000-0001-5026-8740 ; 0000-0002-5590-8601</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,550,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34971370$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-183250$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:148792866$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Qadri, Sami</creatorcontrib><creatorcontrib>Ahlholm, Noora</creatorcontrib><creatorcontrib>Lønsmann, Ida</creatorcontrib><creatorcontrib>Pellegrini, Paola</creatorcontrib><creatorcontrib>Poikola, Anni</creatorcontrib><creatorcontrib>Luukkonen, Panu K</creatorcontrib><creatorcontrib>Porthan, Kimmo</creatorcontrib><creatorcontrib>Juuti, Anne</creatorcontrib><creatorcontrib>Sammalkorpi, Henna</creatorcontrib><creatorcontrib>Penttilä, Anne K</creatorcontrib><creatorcontrib>D'Ambrosio, Roberta</creatorcontrib><creatorcontrib>Soardo, Giorgio</creatorcontrib><creatorcontrib>Leeming, Diana J</creatorcontrib><creatorcontrib>Karsdal, Morten</creatorcontrib><creatorcontrib>Arola, Johanna</creatorcontrib><creatorcontrib>Kechagias, Stergios</creatorcontrib><creatorcontrib>Pelusi, Serena</creatorcontrib><creatorcontrib>Ekstedt, Mattias</creatorcontrib><creatorcontrib>Valenti, Luca</creatorcontrib><creatorcontrib>Hagström, Hannes</creatorcontrib><creatorcontrib>Yki-Järvinen, Hannele</creatorcontrib><title>Obesity Modifies the Performance of Fibrosis Biomarkers in Nonalcoholic Fatty Liver Disease</title><title>The journal of clinical endocrinology and metabolism</title><addtitle>J Clin Endocrinol Metab</addtitle><description>Guidelines recommend blood-based fibrosis biomarkers to identify advanced nonalcoholic fatty liver disease (NAFLD), which is particularly prevalent in patients with obesity.
To study whether the degree of obesity affects the performance of liver fibrosis biomarkers in NAFLD.
Cross-sectional cohort study comparing simple fibrosis scores [Fibrosis-4 Index (FIB-4); NAFLD Fibrosis Score (NFS); aspartate aminotransferase to platelet ratio index; BARD (body mass index, aspartate-to-alanine aminotransferase ratio, diabetes); Hepamet Fibrosis Score (HFS)] and newer scores incorporating neo-epitope biomarkers PRO-C3 (ADAPT, FIBC3) or cytokeratin 18 (MACK-3).
Tertiary referral center.
We recruited overweight/obese patients from endocrinology (n = 307) and hepatology (n = 71) clinics undergoing a liver biopsy [median body mass index (BMI) 40.3 (interquartile range 36.0-44.7) kg/m2]. Additionally, we studied 859 less obese patients with biopsy-proven NAFLD to derive BMI-adjusted cutoffs for NFS.
Biomarker area under the receiver operating characteristic (AUROC), sensitivity, specificity, and predictive values to identify histological stage ≥F3 fibrosis or nonalcoholic steatohepatitis with ≥F2 fibrosis [fibrotic nonalcoholic steatohepatitis (NASH)].
The scores with an AUROC ≥0.85 to identify ≥F3 fibrosis were ADAPT, FIB-4, FIBC3, and HFS. For fibrotic NASH, the best predictors were MACK-3 and ADAPT. The specificities of NFS, BARD, and FIBC3 deteriorated as a function of BMI. We derived and validated new cutoffs for NFS to rule in/out ≥F3 fibrosis in groups with BMIs <30.0, 30.0 to 39.9, and ≥40.0 kg/m2. This optimized its performance at all levels of BMI. Sequentially combining FIB-4 with ADAPT or FIBC3 increased specificity to diagnose ≥F3 fibrosis.
In obese patients, the best-performing fibrosis biomarkers are ADAPT and the inexpensive FIB-4, which are unaffected by BMI. The widely used NFS loses specificity in obese individuals, which may be corrected with BMI-adjusted cutoffs.</description><subject>Antigenic determinants</subject><subject>Aspartate</subject><subject>Aspartate Aminotransferases</subject><subject>Biological markers</subject><subject>Biomarkers</subject><subject>Biopsy</subject><subject>Body mass index</subject><subject>Cross-Sectional Studies</subject><subject>Fatty liver</subject><subject>Fibrosis</subject><subject>Humans</subject><subject>Keratin</subject><subject>Liver - pathology</subject><subject>Liver cirrhosis</subject><subject>Liver Cirrhosis - diagnosis</subject><subject>Liver Cirrhosis - etiology</subject><subject>Liver Cirrhosis - pathology</subject><subject>Medical research</subject><subject>Medicine, Experimental</subject><subject>Non-alcoholic Fatty Liver Disease - complications</subject><subject>Non-alcoholic Fatty Liver Disease - diagnosis</subject><subject>Non-alcoholic Fatty Liver Disease - pathology</subject><subject>Obesity</subject><subject>Obesity - complications</subject><subject>Obesity - pathology</subject><subject>Online Only</subject><subject>Type 2 diabetes</subject><issn>0021-972X</issn><issn>1945-7197</issn><issn>1945-7197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>D8T</sourceid><recordid>eNp9kk1v1DAQhi0EokvhyhFZ4sIlrT_iJL4gbVsWKm0pB0BIHCzHGe8OTeJiZ4v673G7S9VKFfLB1swz78zILyGvOTvggrND1-MIw2G3sq2W8gmZcV2qoua6fkpmjAle6Fr82CMvUvrFGC9LJZ-TPVnqmsuazcjP8xYSTtf0LHToERKd1kC_QPQhDnZ0QIOnC2xjSJjoEYbBxguIieJIP4fR9i6sQ4-OLuyUVZZ4BZGeYAKb4CV55m2f4NXu3iffFh--Hn8qlucfT4_ny8IpracCuPfCl6Vvylo6KzonrGwVMF41DatUXbnGVarVrQDeaVb5FjRTyjfWats6uU-KrW76A5eb1lxGzFNem2DR7EIX-QWmVFlN_pc_we9zE-LK9LgxvJFCscy_3_IZHqBzME7R9g_KHmZGXJtVuDI6r1BWZRZ4txOI4fcG0mQGTA763o4QNsmIiiudm932ertFV7YHg6MPWdHd4GZe15UWkjU8UwePUPl0MKALI3jM8ccKXP7IFMHfTc-ZuTGS2RrJ7IyUC97c3_kO_-cc-ReDlMgJ</recordid><startdate>20220419</startdate><enddate>20220419</enddate><creator>Qadri, Sami</creator><creator>Ahlholm, Noora</creator><creator>Lønsmann, Ida</creator><creator>Pellegrini, Paola</creator><creator>Poikola, Anni</creator><creator>Luukkonen, Panu K</creator><creator>Porthan, Kimmo</creator><creator>Juuti, Anne</creator><creator>Sammalkorpi, Henna</creator><creator>Penttilä, Anne K</creator><creator>D'Ambrosio, Roberta</creator><creator>Soardo, Giorgio</creator><creator>Leeming, Diana J</creator><creator>Karsdal, Morten</creator><creator>Arola, Johanna</creator><creator>Kechagias, Stergios</creator><creator>Pelusi, Serena</creator><creator>Ekstedt, Mattias</creator><creator>Valenti, Luca</creator><creator>Hagström, Hannes</creator><creator>Yki-Järvinen, Hannele</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>ABXSW</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>DG8</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0003-3181-5651</orcidid><orcidid>https://orcid.org/0000-0003-3865-5507</orcidid><orcidid>https://orcid.org/0000-0001-7614-739X</orcidid><orcidid>https://orcid.org/0000-0002-8474-1759</orcidid><orcidid>https://orcid.org/0000-0002-4256-140X</orcidid><orcidid>https://orcid.org/0000-0001-7480-8959</orcidid><orcidid>https://orcid.org/0000-0001-8909-0345</orcidid><orcidid>https://orcid.org/0000-0001-6766-1549</orcidid><orcidid>https://orcid.org/0000-0003-2085-679X</orcidid><orcidid>https://orcid.org/0000-0001-9313-9324</orcidid><orcidid>https://orcid.org/0000-0001-5026-8740</orcidid><orcidid>https://orcid.org/0000-0002-5590-8601</orcidid></search><sort><creationdate>20220419</creationdate><title>Obesity Modifies the Performance of Fibrosis Biomarkers in Nonalcoholic Fatty Liver Disease</title><author>Qadri, Sami ; Ahlholm, Noora ; Lønsmann, Ida ; Pellegrini, Paola ; Poikola, Anni ; Luukkonen, Panu K ; Porthan, Kimmo ; Juuti, Anne ; Sammalkorpi, Henna ; Penttilä, Anne K ; D'Ambrosio, Roberta ; Soardo, Giorgio ; Leeming, Diana J ; Karsdal, Morten ; Arola, Johanna ; Kechagias, Stergios ; Pelusi, Serena ; Ekstedt, Mattias ; Valenti, Luca ; Hagström, Hannes ; Yki-Järvinen, Hannele</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c599t-e1ff2f44f8473ca2dc2a3b5e0168806576c8c65b9b2e1d906fbe9055f8aa9abc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Antigenic determinants</topic><topic>Aspartate</topic><topic>Aspartate Aminotransferases</topic><topic>Biological markers</topic><topic>Biomarkers</topic><topic>Biopsy</topic><topic>Body mass index</topic><topic>Cross-Sectional Studies</topic><topic>Fatty liver</topic><topic>Fibrosis</topic><topic>Humans</topic><topic>Keratin</topic><topic>Liver - pathology</topic><topic>Liver cirrhosis</topic><topic>Liver Cirrhosis - diagnosis</topic><topic>Liver Cirrhosis - etiology</topic><topic>Liver Cirrhosis - pathology</topic><topic>Medical research</topic><topic>Medicine, Experimental</topic><topic>Non-alcoholic Fatty Liver Disease - complications</topic><topic>Non-alcoholic Fatty Liver Disease - diagnosis</topic><topic>Non-alcoholic Fatty Liver Disease - pathology</topic><topic>Obesity</topic><topic>Obesity - complications</topic><topic>Obesity - pathology</topic><topic>Online Only</topic><topic>Type 2 diabetes</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Qadri, Sami</creatorcontrib><creatorcontrib>Ahlholm, Noora</creatorcontrib><creatorcontrib>Lønsmann, Ida</creatorcontrib><creatorcontrib>Pellegrini, Paola</creatorcontrib><creatorcontrib>Poikola, Anni</creatorcontrib><creatorcontrib>Luukkonen, Panu K</creatorcontrib><creatorcontrib>Porthan, Kimmo</creatorcontrib><creatorcontrib>Juuti, Anne</creatorcontrib><creatorcontrib>Sammalkorpi, Henna</creatorcontrib><creatorcontrib>Penttilä, Anne K</creatorcontrib><creatorcontrib>D'Ambrosio, Roberta</creatorcontrib><creatorcontrib>Soardo, Giorgio</creatorcontrib><creatorcontrib>Leeming, Diana J</creatorcontrib><creatorcontrib>Karsdal, Morten</creatorcontrib><creatorcontrib>Arola, Johanna</creatorcontrib><creatorcontrib>Kechagias, Stergios</creatorcontrib><creatorcontrib>Pelusi, Serena</creatorcontrib><creatorcontrib>Ekstedt, Mattias</creatorcontrib><creatorcontrib>Valenti, Luca</creatorcontrib><creatorcontrib>Hagström, Hannes</creatorcontrib><creatorcontrib>Yki-Järvinen, Hannele</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SWEPUB Linköpings universitet full text</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SWEPUB Linköpings universitet</collection><collection>SwePub Articles full text</collection><jtitle>The journal of clinical endocrinology and metabolism</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Qadri, Sami</au><au>Ahlholm, Noora</au><au>Lønsmann, Ida</au><au>Pellegrini, Paola</au><au>Poikola, Anni</au><au>Luukkonen, Panu K</au><au>Porthan, Kimmo</au><au>Juuti, Anne</au><au>Sammalkorpi, Henna</au><au>Penttilä, Anne K</au><au>D'Ambrosio, Roberta</au><au>Soardo, Giorgio</au><au>Leeming, Diana J</au><au>Karsdal, Morten</au><au>Arola, Johanna</au><au>Kechagias, Stergios</au><au>Pelusi, Serena</au><au>Ekstedt, Mattias</au><au>Valenti, Luca</au><au>Hagström, Hannes</au><au>Yki-Järvinen, Hannele</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Obesity Modifies the Performance of Fibrosis Biomarkers in Nonalcoholic Fatty Liver Disease</atitle><jtitle>The journal of clinical endocrinology and metabolism</jtitle><addtitle>J Clin Endocrinol Metab</addtitle><date>2022-04-19</date><risdate>2022</risdate><volume>107</volume><issue>5</issue><spage>e2008</spage><epage>e2020</epage><pages>e2008-e2020</pages><issn>0021-972X</issn><issn>1945-7197</issn><eissn>1945-7197</eissn><abstract>Guidelines recommend blood-based fibrosis biomarkers to identify advanced nonalcoholic fatty liver disease (NAFLD), which is particularly prevalent in patients with obesity.
To study whether the degree of obesity affects the performance of liver fibrosis biomarkers in NAFLD.
Cross-sectional cohort study comparing simple fibrosis scores [Fibrosis-4 Index (FIB-4); NAFLD Fibrosis Score (NFS); aspartate aminotransferase to platelet ratio index; BARD (body mass index, aspartate-to-alanine aminotransferase ratio, diabetes); Hepamet Fibrosis Score (HFS)] and newer scores incorporating neo-epitope biomarkers PRO-C3 (ADAPT, FIBC3) or cytokeratin 18 (MACK-3).
Tertiary referral center.
We recruited overweight/obese patients from endocrinology (n = 307) and hepatology (n = 71) clinics undergoing a liver biopsy [median body mass index (BMI) 40.3 (interquartile range 36.0-44.7) kg/m2]. Additionally, we studied 859 less obese patients with biopsy-proven NAFLD to derive BMI-adjusted cutoffs for NFS.
Biomarker area under the receiver operating characteristic (AUROC), sensitivity, specificity, and predictive values to identify histological stage ≥F3 fibrosis or nonalcoholic steatohepatitis with ≥F2 fibrosis [fibrotic nonalcoholic steatohepatitis (NASH)].
The scores with an AUROC ≥0.85 to identify ≥F3 fibrosis were ADAPT, FIB-4, FIBC3, and HFS. For fibrotic NASH, the best predictors were MACK-3 and ADAPT. The specificities of NFS, BARD, and FIBC3 deteriorated as a function of BMI. We derived and validated new cutoffs for NFS to rule in/out ≥F3 fibrosis in groups with BMIs <30.0, 30.0 to 39.9, and ≥40.0 kg/m2. This optimized its performance at all levels of BMI. Sequentially combining FIB-4 with ADAPT or FIBC3 increased specificity to diagnose ≥F3 fibrosis.
In obese patients, the best-performing fibrosis biomarkers are ADAPT and the inexpensive FIB-4, which are unaffected by BMI. The widely used NFS loses specificity in obese individuals, which may be corrected with BMI-adjusted cutoffs.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>34971370</pmid><doi>10.1210/clinem/dgab933</doi><orcidid>https://orcid.org/0000-0003-3181-5651</orcidid><orcidid>https://orcid.org/0000-0003-3865-5507</orcidid><orcidid>https://orcid.org/0000-0001-7614-739X</orcidid><orcidid>https://orcid.org/0000-0002-8474-1759</orcidid><orcidid>https://orcid.org/0000-0002-4256-140X</orcidid><orcidid>https://orcid.org/0000-0001-7480-8959</orcidid><orcidid>https://orcid.org/0000-0001-8909-0345</orcidid><orcidid>https://orcid.org/0000-0001-6766-1549</orcidid><orcidid>https://orcid.org/0000-0003-2085-679X</orcidid><orcidid>https://orcid.org/0000-0001-9313-9324</orcidid><orcidid>https://orcid.org/0000-0001-5026-8740</orcidid><orcidid>https://orcid.org/0000-0002-5590-8601</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0021-972X |
| ispartof | The journal of clinical endocrinology and metabolism, 2022-04, Vol.107 (5), p.e2008-e2020 |
| issn | 0021-972X 1945-7197 1945-7197 |
| language | eng |
| recordid | cdi_swepub_primary_oai_swepub_ki_se_456573 |
| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection; SWEPUB Freely available online |
| subjects | Antigenic determinants Aspartate Aspartate Aminotransferases Biological markers Biomarkers Biopsy Body mass index Cross-Sectional Studies Fatty liver Fibrosis Humans Keratin Liver - pathology Liver cirrhosis Liver Cirrhosis - diagnosis Liver Cirrhosis - etiology Liver Cirrhosis - pathology Medical research Medicine, Experimental Non-alcoholic Fatty Liver Disease - complications Non-alcoholic Fatty Liver Disease - diagnosis Non-alcoholic Fatty Liver Disease - pathology Obesity Obesity - complications Obesity - pathology Online Only Type 2 diabetes |
| title | Obesity Modifies the Performance of Fibrosis Biomarkers in Nonalcoholic Fatty Liver Disease |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-06T03%3A48%3A37IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_swepu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Obesity%20Modifies%20the%20Performance%20of%20Fibrosis%20Biomarkers%20in%20Nonalcoholic%20Fatty%20Liver%20Disease&rft.jtitle=The%20journal%20of%20clinical%20endocrinology%20and%20metabolism&rft.au=Qadri,%20Sami&rft.date=2022-04-19&rft.volume=107&rft.issue=5&rft.spage=e2008&rft.epage=e2020&rft.pages=e2008-e2020&rft.issn=0021-972X&rft.eissn=1945-7197&rft_id=info:doi/10.1210/clinem/dgab933&rft_dat=%3Cgale_swepu%3EA776923081%3C/gale_swepu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2615918350&rft_id=info:pmid/34971370&rft_galeid=A776923081&rfr_iscdi=true |