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Peer-reviewedCC BY 4.0Diabetes, Obesity & Metabolism

Non‐Invasive Fibrosis Testing in Adults With Obesity and MASLD: A Systematic Review and Meta‐Analysis

  • Patricia M. Ortega1
  • Lucas Sabatella2
  • Pinelopi Manousou3,4
  • Adriana Arregui5
  • Ahmed R. Ahmed1,6
  • Chioma Izzi‐Engbeaya4,7
7 affiliations
  1. 1Department of Surgery Imperial College Healthcare NHS Trust London UK
  2. 2Bariatric Unit, Department of General Surgery Clínica Universidad de Navarra Pamplona Spain
  3. 3Department of Gastroenterology and Hepatology Imperial College Healthcare NHS Trust London UK
  4. 4Department of Metabolism, Digestion and Reproduction Imperial College London London UK
  5. 5Area of Practice Improvement and Innovation in Nursing Clínica Universidad de Navarra Pamplona Spain
  6. 6Department of Surgery and Cancer Imperial College London London UK
  7. 7Department of Endocrinology Imperial College Healthcare NHS Trust London UK
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Abstract

Aims: Adults with obesity are at increased risk of metabolic dysfunction‐associated steatotic liver disease (MASLD)‐related fibrosis, but the diagnostic performance of non‐invasive tests (NITs) in this population remains uncertain. This meta‐analysis evaluated NITs for detecting significant (≥F2) and advanced (≥F3) fibrosis in adults with obesity and MASLD.

Materials and Methods: PubMed/MEDLINE, Embase, Web of Science and the Cochrane Library were searched from inception to 1 December 2025. Eligible studies enrolled adults with obesity (BMI ≥ 30 kg/m2) and MASLD, compared an NIT with liver biopsy, and provided data to estimate sensitivity and specificity. Pooled estimates were derived using bivariate random‐effects models; HSROC curves were generated for each test and fibrosis threshold.

Results: Twenty‐seven studies including 5034 participants were included. Mean age was 40.6 ± 11.4 years and mean BMI was 43.3 ± 7.1 kg/m2. For significant fibrosis (≥F2), vibration‐controlled transient elastography (VCTE) showed a sensitivity of 0.64 (95% CI, 0.49–0.77) and specificity of 0.77 (95% CI, 0.66–0.85), with a median threshold of 7.95 kPa (IQR, 7.60–12.00). FIB‐4 showed broadly comparable performance, with a sensitivity of 0.65 (95% CI, 0.53–0.75) and specificity of 0.77 (95% CI, 0.64–0.86). For advanced fibrosis (≥F3), VCTE showed a sensitivity of 0.77 (95% CI, 0.67–0.85) and specificity of 0.84 (95% CI, 0.76–0.90), with a median threshold of 10.73 kPa (IQR, 8.15–12.80). Serum‐based tests showed more variable operating characteristics. Post hoc threshold analyses showed the expected trade‐off between sensitivity and specificity at lower VCTE cut‐offs.

Conclusions: In adults with obesity and MASLD, VCTE showed the most consistent diagnostic performance, particularly for advanced fibrosis, whereas serum‐based tests demonstrated more variable operating characteristics. Threshold selection and technical feasibility remain important determinants of performance, highlighting the need for validated obesity‐specific thresholds and diagnostic pathways.

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Cite

BibTeXRIS
BibTeX
@article{ortega2026noninvasive,
  title = {{Non‐Invasive Fibrosis Testing in Adults With Obesity and MASLD: A Systematic Review and Meta‐Analysis}},
  author = {Patricia M. Ortega and Lucas Sabatella and Pinelopi Manousou and Adriana Arregui and Ahmed R. Ahmed and Chioma Izzi‐Engbeaya},
  journal = {Diabetes, Obesity \& Metabolism},
  year = {2026},
  month = sep,
  doi = {10.1111/dom.71357},
  url = {https://doi.org/10.1111/dom.71357},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Non‐Invasive Fibrosis Testing in Adults With Obesity and MASLD: A Systematic Review and Meta‐Analysis
AU  - Patricia M. Ortega
AU  - Lucas Sabatella
AU  - Pinelopi Manousou
AU  - Adriana Arregui
AU  - Ahmed R. Ahmed
AU  - Chioma Izzi‐Engbeaya
PY  - 2026
DA  - 2026/09/17
JO  - Diabetes, Obesity & Metabolism
DO  - 10.1111/dom.71357
UR  - https://doi.org/10.1111/dom.71357
AB  - Aims: Adults with obesity are at increased risk of metabolic dysfunction‐associated steatotic liver disease (MASLD)‐related fibrosis, but the diagnostic performance of non‐invasive tests (NITs) in this population remains uncertain. This meta‐analysis evaluated NITs for detecting significant (≥F2) and advanced (≥F3) fibrosis in adults with obesity and MASLD.  Materials and Methods: PubMed/MEDLINE, Embase, Web of Science and the Cochrane Library were searched from inception to 1 December 2025. Eligible studies enrolled adults with obesity (BMI ≥ 30 kg/m2) and MASLD, compared an NIT with liver biopsy, and provided data to estimate sensitivity and specificity. Pooled estimates were derived using bivariate random‐effects models; HSROC curves were generated for each test and fibrosis threshold.  Results: Twenty‐seven studies including 5034 participants were included. Mean age was 40.6 ± 11.4 years and mean BMI was 43.3 ± 7.1 kg/m2. For significant fibrosis (≥F2), vibration‐controlled transient elastography (VCTE) showed a sensitivity of 0.64 (95% CI, 0.49–0.77) and specificity of 0.77 (95% CI, 0.66–0.85), with a median threshold of 7.95 kPa (IQR, 7.60–12.00). FIB‐4 showed broadly comparable performance, with a sensitivity of 0.65 (95% CI, 0.53–0.75) and specificity of 0.77 (95% CI, 0.64–0.86). For advanced fibrosis (≥F3), VCTE showed a sensitivity of 0.77 (95% CI, 0.67–0.85) and specificity of 0.84 (95% CI, 0.76–0.90), with a median threshold of 10.73 kPa (IQR, 8.15–12.80). Serum‐based tests showed more variable operating characteristics. Post hoc threshold analyses showed the expected trade‐off between sensitivity and specificity at lower VCTE cut‐offs.  Conclusions: In adults with obesity and MASLD, VCTE showed the most consistent diagnostic performance, particularly for advanced fibrosis, whereas serum‐based tests demonstrated more variable operating characteristics. Threshold selection and technical feasibility remain important determinants of performance, highlighting the need for validated obesity‐specific thresholds and diagnostic pathways.
SN  - 1462-8902
SN  - 1463-1326
ER  -