Discordance Between FIB-4 and BAST Fibrosis Risk Classifications in Obese Patients with MASLD: Results from the OBREDI-TR Study

<b>Background/Objectives</b>: Non-invasive fibrosis scores are widely used for risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD); however, their performance in obese individuals remains controversial. The Fibrosis-4 (FIB-4) index is commonly recommended as a first-line tool, yet it may underestimate fibrosis risk in severe obesity. The BAST score, which incorporates metabolic and anthropometric parameters, has been proposed as an alternative. This study aimed to characterize both the degree and direction of discordance between FIB-4 and BAST in obese patients with MASLD. <b>Methods</b>: This predefined secondary analysis included 2950 adults with obesity (BMI ≥ 30 kg/m<sup>2</sup>) and MASLD from the multicenter OBREDI-TR cohort. Fibrosis risk categories were assigned using standard cut-offs for FIB-4 and BAST, and agreement was assessed using weighted Cohen's kappa. Associations among discordance patterns, obesity class, and the visceral adiposity index (VAI) were evaluated using chi-square tests and general linear models. <b>Results</b>: Overall agreement between FIB-4 and BAST was very poor (κ = 0.041, <i>p</i> < 0.001). Discordance was observed in 22.3% of patients and increased markedly with obesity severity. In class III obesity, discordance was predominantly driven by low-risk classification according to FIB-4 despite high-risk classification according to BAST. Patients with this discordant pattern exhibited significantly higher VAI values than concordant cases (<i>p</i> < 0.001), independently of the study center. <b>Conclusions</b>: In obese patients with MASLD, particularly those with morbid obesity, FIB-4 frequently classifies patients as low risk, while BAST identifies elevated fibrosis risk. This systematic discordance suggests that FIB-4 may underestimate fibrosis burden in the context of severe obesity and visceral adiposity, supporting the need for a phenotype-oriented, multimodal approach to fibrosis risk assessment.

Authors

Institutions

Publication Details

Journal
Diagnostics
Published
2026-02-12
DOI
https://doi.org/10.3390/diagnostics16040547
Primary Topic
Liver Disease Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Discordance Between FIB-4 and BAST Fibrosis Risk Classifications in Obese Patients with MASLD: Results from the OBREDI-TR Study

Alper Tuna Güven, Nalan Okuroğlu, Ahmet Dündar, Celalettin Küçük et al.
Diagnostics
Liver Disease Diagnosis and Treatment
article

Discordance Between FIB-4 and BAST Fibrosis Risk Classifications in Obese Patients with MASLD: Results from the OBREDI-TR Study

Alper Tuna Güven, Nalan Okuroğlu, Ahmet Dündar, Celalettin Küçük, Mehmet Kök, İhsan Solmaz, Osman Özüdoğru, Nur Düzen Oflas, Gökhan TAZEGÜL, Hacer Şen, Atilla Onmez, Aycan Acet, Sibel Ocak Serin, Alihan Oral, Selçuk Yaylacı, Uğur Korkmaz, Ali Burak Govez, Yusuf Usame Durmus, Nizameddin Koca, Teslime Ayaz, Aysegul Ertinmaz, Zeynep Irmak Kaya, Esref Arac, Ahmet Aydin, Nazif Yalcin, Aysun Isiklar, Ozge Kama Basci, Hasan Sozel, Hamit YILDIZ, Kubilay Issever, Ali Kirik, Hilmi Erdem Sumbul, Hüseyin Ali Öztürk, Seyit Uyar, Kamil Konur, Yasin Sahinturk, Emine Binnetoglu, Ismail Demir
article en

Abstract

<b>Background/Objectives</b>: Non-invasive fibrosis scores are widely used for risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD); however, their performance in obese individuals remains controversial. The Fibrosis-4 (FIB-4) index is commonly recommended as a first-line tool, yet it may underestimate fibrosis risk in severe obesity. The BAST score, which incorporates metabolic and anthropometric parameters, has been proposed as an alternative. This study aimed to characterize both the degree and direction of discordance between FIB-4 and BAST in obese patients with MASLD. <b>Methods</b>: This predefined secondary analysis included 2950 adults with obesity (BMI ≥ 30 kg/m<sup>2</sup>) and MASLD from the multicenter OBREDI-TR cohort. Fibrosis risk categories were assigned using standard cut-offs for FIB-4 and BAST, and agreement was assessed using weighted Cohen's kappa. Associations among discordance patterns, obesity class, and the visceral adiposity index (VAI) were evaluated using chi-square tests and general linear models. <b>Results</b>: Overall agreement between FIB-4 and BAST was very poor (κ = 0.041, <i>p</i> < 0.001). Discordance was observed in 22.3% of patients and increased markedly with obesity severity. In class III obesity, discordance was predominantly driven by low-risk classification according to FIB-4 despite high-risk classification according to BAST. Patients with this discordant pattern exhibited significantly higher VAI values than concordant cases (<i>p</i> < 0.001), independently of the study center. <b>Conclusions</b>: In obese patients with MASLD, particularly those with morbid obesity, FIB-4 frequently classifies patients as low risk, while BAST identifies elevated fibrosis risk. This systematic discordance suggests that FIB-4 may underestimate fibrosis burden in the context of severe obesity and visceral adiposity, supporting the need for a phenotype-oriented, multimodal approach to fibrosis risk assessment.

DiagnosticsVol. 16(4)
Sakarya University (TR), Balıkesir University (TR), Van Yüzüncü Yıl Üniversitesi (TR), Dicle University (TR), Izmir University (TR), Giresun University (TR), Recep Tayyip Erdoğan University (TR), Erzincan Binali Yıldırım University (TR), Başkent University (TR), Bursa Technical University (TR), Akdeniz University (TR), Izmir Kâtip Çelebi University (TR), Turku University Hospital (FI), Kütahya Dumlupınar Üniversitesi (TR), Istanbul Medipol University (TR), Acıbadem University (TR), Eskişehir City Hospital (TR), Biruni University (TR), Antalya Eğitim ve Araştırma Hastanesi (TR), Ümraniye Eğitim ve Araştırma Hastanesi (TR), Memorial Sisli Hospital (TR), Saviour Hospital (IN), Kayseri Eğitim ve Araştırma Hastanesi (TR), Sağlık Bilimleri Üniversitesi (TR), Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi (TR), Istanbul Memorial Hospital (TR), Izmir Bozyaka Eğitim ve Araştırma Hastanesi (TR), Fatih Sultan Mehmet Eğitim Ve Araştırma Hastanesi (TR), Kutahya Saglik Bilimleri Universitesi, Düzce Üniversitesi (TR), Gaziantep University (TR), Marmara University (TR)
No poverty
Openalex Percentile: Top 57%
Liver Disease Diagnosis and Treatment
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.