Prevalence of Non-Alcoholic Fatty Liver Disease in Obese Patients: Comparative Evaluation of the Fibrosis-4 (FIB-4) Index and Aspartate Aminotransferase to Platelet Ratio Index (APRI)

Authors : Banu Açmaz, Sami Bahçebaşı, Nazmiye Serap Biçer, İfakat İrem Biçer, Erdem Aydın, Mehmet Yasin Türkmen, Fahri Bayram, Alper Sönmez

Pages : 298-306

View : 73 | Download : 179

Publication Date : 2025-12-31

Article Type : Research Paper

Abstract :Aim: Non-alcoholic fatty liver disease (NAFLD) is common among individuals with obesity, yet clinical screening remains inadequate. This study aimed to assess ultrasonography (US) utilization and the relationship between APRI and FIB-4 scores and hepatic steatosis in an obesity-clinic population. Material and Methods: This retrospective single-center cross-sectional study included 1,420 adults evaluated over one year. Clinical and laboratory data were retrieved from medical records. Previous abdominal US reports were available for 367 patients. Fibrosis risk was defined as FIB-4 ≥1.3 and APRI ≥1. Group comparisons were performed using Kruskal–Wallis, Mann–Whitney U, and Chi-square tests, and normality was assessed with the Shapiro–Wilk test. Results: US was available in 25.8% of patients, and hepatic steatosis was detected in 63.2% of those examined. APRI ≥1 classified 31.1% of the cohort at fibrosis risk, whereas FIB-4 ≥1.3 identified only 3.5%. APRI values were independent of BMI and glycemic status but were higher in patients with steatosis (p<0.001). FIB-4 increased with higher BMI and HbA1c, reflecting the influence of age in its formula, as metabolic deterioration and obesity severity progress with aging. Conclusion: The low rate of ultrasonography use in obesity clinics indicates insufficient awareness of NAFLD. Obesity represents a significant risk factor for NAFLD and progressive liver failure. Liver biopsy is invasive, elastography is not widely available, and these gold standard diagnostic methods do not alter treatment decisions or outcomes. The ability of APRI to identify a larger subgroup of patients at fibrosis risk, independent of age, may enhance awareness and promote earlier preventive interventions. Therefore, the broader implementation of noninvasive fibrosis scores should be encouraged in clinical practice.
Keywords : APRI, FIB-4, Non-alkolik yağlı karaciğer hastalığı, Obezite, Ultrasonografi

ORIGINAL ARTICLE URL