Vibration‐Controlled Transient Elastography (VCTE)‐Based Prevalence and Assessment of Hepatic Steatosis and Fibrosis in a UK Tertiary Hospital‐Based Specialist Weight Management Service: A Real‐World Evaluation
Scott A. Willis, Masato Ahsan, Kiran Rathi, Ian Lawrence, Melanie J. Davies, David R. Webb, James A. King, Ehtasham AhmadABSTRACT
Background
Metabolic dysfunction‐associated steatotic liver disease is common in severe obesity; however, liver health assessment is inconsistently implemented in specialist weight management services and real‐world data are scarce. This study evaluated the prevalence and severity of vibration‐controlled transient elastography (VCTE)‐defined hepatic steatosis and fibrosis risk in adults attending a UK‐based Tier 3 specialist weight management service, and explored associations with clinical and metabolic characteristics.
Methods
This retrospective cross‐sectional study included 96 adults referred to a specialist weight management service who underwent baseline VCTE (FibroScan) between June 2024 and November 2025. Controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) estimated hepatic steatosis and fibrosis risk, respectively. Demographic, anthropometric, clinical, and biochemical variables were extracted from electronic records. Generalized linear models identified factors associated with CAP and LSM, with sensitivity analyses adjusting for incretin‐based therapy use.
Results
Participants were predominantly female (83.3%) and White European (81.3%), with mean age 48.7 ± 12.5 years and BMI 42.0 ± 9.4 kg/m 2 . VCTE‐defined steatosis was present in 82.3% (CAP ≥ 248 dB·m −1 ), with 57.3% classified as severe (CAP ≥ 280 dB·m‐ 1 ). Overall, 26.1% had elevated fibrosis risk (LSM ≥ 8 kPa), including 6.3% classified as high risk (LSM > 12 kPa). In multivariable analyses, higher BMI, HbA1c and ALT were independently associated with greater CAP, whereas BMI and HbA1c were independently associated with higher LSM. Further adjustment for incretin‐based pharmacotherapy use did not alter these relationships.
Conclusions
Hepatic steatosis and elevated fibrosis risk are highly prevalent in adults attending specialist weight management services. Adiposity and glycemic burden appear to be key determinants, supporting the integration of non‐invasive liver assessment into specialist obesity care pathways.