Lipids & metabolic liver disease
Non‐Invasive Fibrosis Testing in Adults With Obesity and MASLD : A Systematic Review and Meta‐Analysis
Authors' conclusion
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.
Study context
- Population
- Adults with obesity (BMI ≥ 30 kg/m²) and MASLD; mean age 40.6 ± 11.4 years, mean BMI 43.3 ± 7.1 kg/m²
- Participants
- 5,034 adults27 studies
- Comparison
- Non-invasive fibrosis tests vs liver biopsy
- Outcome
- Diagnostic performance (sensitivity, specificity) for significant (≥F2) and advanced (≥F3) fibrosis vs liver biopsy
Methodological detailsbivariate random-effects models, HSROC curves, Searched PubMed/MEDLINE, Embase, Web of Science and Cochrane Library to 1 December 2025
- Bivariate random-effects models
- HSROC curves
- Searched PubMed/MEDLINE, Embase, Web of Science and Cochrane Library to 1 December 2025
Pooled result
As reported in the abstract
Significant fibrosis (≥F2)
| Group | Sensitivity | Specificity | Median threshold |
|---|---|---|---|
| Vibration-controlled transient elastography (VCTE) | 0.64 (95% CI, 0.49-0.77) | 0.77 (95% CI, 0.66-0.85) | 7.95 kPa (IQR, 7.60-12.00) |
| FIB-4 | 0.65 (95% CI, 0.53-0.75) | 0.77 (95% CI, 0.64-0.86) |
Sensitivity
Vibration-controlled transient elastography (VCTE)0.64 (95% CI, 0.49-0.77)
FIB-40.65 (95% CI, 0.53-0.75)
Specificity
Vibration-controlled transient elastography (VCTE)0.77 (95% CI, 0.66-0.85)
FIB-40.77 (95% CI, 0.64-0.86)
Median threshold
Vibration-controlled transient elastography (VCTE)7.95 kPa (IQR, 7.60-12.00)
FIB-4— not stated in the abstract
Further pooled results
| Outcome | VCTE |
|---|---|
| Advanced fibrosis (≥F3) | |
| Sensitivity | 0.77 (95% CI, 0.67-0.85) |
| Specificity | 0.84 (95% CI, 0.76-0.90) |
| Median threshold | 10.73 kPa (IQR, 8.15-12.80) |
Serum-based tests
- Serum-based tests showed more variable operating characteristics
Post hoc VCTE threshold analyses
- Expected trade-off between sensitivity and specificity at lower VCTE cut-offs
- Post hoc
Original publication
Non‐Invasive Fibrosis Testing in Adults With Obesity and MASLD : A Systematic Review and Meta‐Analysis. Diabetes Obes Metab. Published 17 September 2026. doi:10.
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