Diabetes and obesity reduce FIB-4 accuracy in MASLD referral pathways

JHEP Reports 2026 Open access

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Authors: Abdel-Aziz Shaheen, Elizabeth Baguley, Mark G. Swain, Matthew Tam, Mang Ming Ma, Giada Sebastiani, Jason Jiang, Frank Shin-Haw Lee, Alexandra Medellin, Juan G. Abraldeṣ
DOI: 10.1016/j.jhepr.2026.101735
Cited by: 6
References: 43

Abstract

Background & Aims Primary care referral pathways often use FIB-4 to triage metabolic dysfunction-associated steatotic liver disease (MASLD), but its accuracy may vary by patient characteristics. We aimed to evaluate FIB-4 performance against elastography, compare it with other non-invasive tests, assess effect modification by BMI, diabetes, sex, ALT, and age, and calibrate 2D shear-wave elastography (2D-SWE) and vibration-controlled transient elastography (VCTE) thresholds. Methods We analyzed two cohorts with paired serum scores and elastography: Calgary (2D-SWE; N=8,126) and Edmonton (VCTE; N=985). We summarized fibrosis-risk distributions and used exceedance probabilities to align 2D-SWE with guideline-recommended VCTE cut-offs. Results In the Calgary cohort, median 2D-SWE was 4.6 kPa (IQR 3.9–5.8) and 9% had liver stiffness ≥8 kPa; FIB-4 was

Fields of Study & Subjects

Parathyroid Disorders and Treatments Cardiovascular Function and Risk Factors Bariatric Surgery and Outcomes

Publication details

Journal / source
JHEP Reports
Publisher
Elsevier BV
Volume
8
Issue
4
Pages
101735–101735
Publication date
12 January 2026
Language
EN