FIB-4: a screening tool for advanced liver fibrosis in a cohort of subjects participating in a primary care weight-loss program

Abstract Systematic screening for liver fibrosis using FIB-4 score is recommended in primary care for patients with chronic liver disease risk factors. This study assesses the prevalence and characteristics of patients at risk for advanced fibrosis in a weight loss program. This multicenter retrospective cohort study includes obese and overweight subjects participating in a weight loss program across 100 French centers. 27 643 participants with baseline FIB-4 available were included, predominantly women (78.3%), median age of 54 years, 70% obese. Baseline FIB-4 values were  2.67 in 80.9%, 18.1% and 1% of the participants, respectively. When moving from the lower risk category ( 2.67), the rates of metabolic comorbidities such as diabetes rose (from 3.2–13.3%). After 5 [3–7] months, all anthropometric parameters improved. A follow-up FIB-4 value was available in 20,7% participants. Among high-risk, 43% changed classes, 4.6% moving to the lower risk-category. Prevalence of patients at risk for advanced fibrosis according to initial FIB-4 was 19.1%, with higher rates of metabolic comorbidities in higher-risk participants. General practitioners and nutrition professionals play crucial role for implementing the two-step algorithm to screen for advanced fibrosis in patients at risk.