Determinants of advanced non-alcoholic fatty liver disease fibrosis in the obese population

Ranging from simple steatosis to non-alcoholic steatohepatitis (NASH), non-alcoholic fatty liver disease (NAFLD) poses a significant health burden especially in the obese population. The aim of our study was to screen obese patients for fibrosis and identify factors associated with its advanced stage. This is a cross-sectional study conducted in 40 obese female patients. The assessment of NAFLD was based on the use of Fibroscan with advanced fibrosis defined as F2 stage or higher. Mean age was 43.56 ± 12.75 years, mean body weight and body mass index (BMI) were 105.25 ± 16.38 kg and 40.36 ± 7.17 kg/m 2 , respectively, and morbid obesity was observed in 45% of the patients. Abdominal obesity was noted in the entire sample with an average waist circumference of 119.80 ± 14.61 cm. Steatosis was detected in 75% of the population while fibrosis was identified in 90% of patients, of which 37.5% were in the advanced stage. Advanced fibrosis was significantly associated with higher body weight (113.15 ± 18.48 kg vs. 100.50 ± 13.17 kg; P = 0.016), higher BMI (44.41 ± 9.16 kg/m 2 vs. 38.37 ± 4.51 kg/m 2 ; P = 0.008) and increased body fat mass (56.05 ± 14.20 kg vs. 46.20 ± 9.15 kg; P = 0.011). Patients with advanced fibrosis had significantly elevated GGT levels (45.33 ± 46.47 UI/L vs. 23.79 ± 9.24 UI/L; P = 0.033) and lower platelet count (273.21 ± 68.05 1000/mm^3 vs. 330.96 ± 79.62 1000/mm^3; P = 0.03). Data on macro- and micronutrient intake revealed that patients with advanced fibrosis had significantly low dietary fiber intake (87% vs. 48%; P = 0.014) and insufficient manganese intake (24% vs. 4%; P = 0.036). Our study underscores the alarming frequency and severity of fibrosis among obese adult patients.