{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:09:43Z","timestamp":1789711783309,"version":"4.0.1"},"reference-count":63,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100013342","name":"NIHR Imperial Biomedical Research Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013342","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001922","name":"Efficacy and Mechanism Evaluation Programme","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001922","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Adults with obesity are at increased risk of metabolic dysfunction\u2010associated steatotic liver disease (MASLD)\u2010related fibrosis, but the diagnostic performance of non\u2010invasive tests (NITs) in this population remains uncertain. This meta\u2010analysis evaluated NITs for detecting significant (\u2265F2) and advanced (\u2265F3) fibrosis in adults with obesity and MASLD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      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 \u2265\u200930\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) and MASLD, compared an NIT with liver biopsy, and provided data to estimate sensitivity and specificity. Pooled estimates were derived using bivariate random\u2010effects models; HSROC curves were generated for each test and fibrosis threshold.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010seven studies including 5034 participants were included. Mean age was 40.6\u2009\u00b1\u200911.4\u2009years and mean BMI was 43.3\u2009\u00b1\u20097.1\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . For significant fibrosis (\u2265F2), vibration\u2010controlled transient elastography (VCTE) showed a sensitivity of 0.64 (95% CI, 0.49\u20130.77) and specificity of 0.77 (95% CI, 0.66\u20130.85), with a median threshold of 7.95\u2009kPa (IQR, 7.60\u201312.00). FIB\u20104 showed broadly comparable performance, with a sensitivity of 0.65 (95% CI, 0.53\u20130.75) and specificity of 0.77 (95% CI, 0.64\u20130.86). For advanced fibrosis (\u2265F3), VCTE showed a sensitivity of 0.77 (95% CI, 0.67\u20130.85) and specificity of 0.84 (95% CI, 0.76\u20130.90), with a median threshold of 10.73\u2009kPa (IQR, 8.15\u201312.80). Serum\u2010based tests showed more variable operating characteristics. Post hoc threshold analyses showed the expected trade\u2010off between sensitivity and specificity at lower VCTE cut\u2010offs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In adults with obesity and MASLD, VCTE showed the most consistent diagnostic performance, particularly for advanced fibrosis, whereas serum\u2010based tests demonstrated more variable operating characteristics. Threshold selection and technical feasibility remain important determinants of performance, highlighting the need for validated obesity\u2010specific thresholds and diagnostic pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.71357","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:49:56Z","timestamp":1789710596000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Non\u2010Invasive Fibrosis Testing in Adults With Obesity and\n                    <scp>MASLD<\/scp>\n                    : A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","author":[{"given":"Patricia M.","family":"Ortega","sequence":"first","affiliation":[{"name":"Department of Surgery Imperial College Healthcare NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Sabatella","sequence":"additional","affiliation":[{"name":"Bariatric Unit, Department of General Surgery Cl\u00ednica Universidad de Navarra  Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pinelopi","family":"Manousou","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Imperial College Healthcare NHS Trust  London UK"},{"name":"Department of Metabolism, Digestion and Reproduction Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Arregui","sequence":"additional","affiliation":[{"name":"Area of Practice Improvement and Innovation in Nursing Cl\u00ednica Universidad de Navarra  Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed R.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Surgery Imperial College Healthcare NHS Trust  London UK"},{"name":"Department of Surgery and Cancer Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7599-0166","authenticated-orcid":false,"given":"Chioma","family":"Izzi\u2010Engbeaya","sequence":"additional","affiliation":[{"name":"Department of Metabolism, Digestion and Reproduction Imperial College London  London UK"},{"name":"Department of Endocrinology Imperial College Healthcare NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.06.003"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/hep.0000000000000004"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2023.11.005"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2468\u20101253(26)00057\u20109"},{"issue":"2","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1001\/jama.2025.19615","article-title":"Metabolic Dysfunction\u2013Associated Steatotic Liver Disease in Adults","volume":"335","author":"Tilg H.","year":"2025","journal-title":"Journal of the American Medical Association"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468\u20101253(22)00317\u2010X"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2022.04.014"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/hep.0000000000001368"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.70326"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125\u2010024\u201006196\u20103"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aohep.2025.101903"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/obr.12628"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102021\u2010324243"},{"key":"e_1_2_10_15_1","first-page":"1","volume-title":"Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy","author":"Flemyng E.","year":"2023"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.19163"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(24)01811\u20107"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20701"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1411"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695\u2010020\u201004977\u20104"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695\u2010023\u201006766\u20101"},{"issue":"5","key":"e_1_2_10_22_1","doi-asserted-by":"crossref","DOI":"10.3390\/jcm11051201","article-title":"The Utility and Diagnostic Accuracy of Transient Elastography in Adults With Morbid Obesity: A Prospective Study","volume":"11","author":"Ali A. 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