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World J Gastroenterol. Jul 21, 2026; 32(27): 117715
Published online Jul 21, 2026. doi: 10.3748/wjg.117715
Published online Jul 21, 2026. doi: 10.3748/wjg.117715
Non-alcoholic fatty liver disease fibrosis score is a useful tool for carotid atherosclerosis screening in patients with obstructive sleep apnea
Carlos Ernesto Fernández-García, Miguel Á Hernández-García, Carmelo García-Monzón, Biomedical Research Unit, Hospital Universitario Santa Cristina, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid 28009, Spain
Beatriz Aldave-Orzáiz, Elena Ávalos Pérez-Urría, Pedro Landete, Department of Respiratory Medicine, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa Hospital Universitario de La Princesa, Madrid 28006, Spain
José M Muñoz, Alfonsi Friera, Radiodiagnostic Service, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa Hospital Universitario de La Princesa, Madrid 28006, Spain
Pedro Landete, Universidad Autónoma de Madrid, Madrid 28029, Spain
Pedro Landete, Águeda González-Rodríguez, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid 28029, Spain
Águeda González-Rodríguez, Instituto de Investigaciones Biomédicas Sols-Morreale, Consejo Superior de Investigaciones Científicas-Universidad Autónoma de Madrid, Madrid 28029, Spain
Co-first authors: Carlos Ernesto Fernández-García and Miguel Á Hernández-García.
Co-corresponding authors: Pedro Landete and Águeda González-Rodríguez.
Author contributions: Fernández-García CE was primarily responsible for execution of all statistical methods; Hernández-García MÁ contributed to data curation; Fernández-García CE and Hernández-García MÁ contributed to formal statistical analysis, and writing/editing the manuscript, they contributed equally to this article, they are the co-first authors of this manuscript; Aldave-Orzáiz B, Ávalos Pérez-Urría E, Muñoz JM, Friera A, and García-Monzón C contributed to the investigation, collection of clinical data, and provided essential clinical resources; Fernández-García CE, Landete P, and González-Rodríguez Á interpreted and analyzed the data; Landete P and González-Rodríguez Á conceived the study, were responsible for project administration and funding acquisition, and provided expert supervision contributed significantly to the critical revision of the manuscript for intellectual content; they contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors revised the manuscript critically for intellectual content and approved the final version.
Supported by Instituto de Salud Carlos III and Fondo Europeo para el Desarrollo Regional, and Beca SEPAR 2019 from the Spanish Society of Pulmonology and Thoracic Surgery to Pedro Landete, No. PI20/00837; Instituto de Salud Carlos III and Fondo Europeo para el Desarrollo Regional to Águeda González-Rodríguez, No. PI22/01968; Comunidad de Madrid (Spain) and the European Social Fund Plus, No. PEJ-2024-AISAL-GL-32758 to Miguel Ángel Hernández-García; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas funded by Instituto de Salud Carlos III; and Scientific Network Enfermedades Metabólicas funded by the Consejo Superior de Investigaciones Científicas.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Institution’s Clinical Research, approval No. PI/2800-16.
Informed consent statement: All participants signed a written informed consent before inclusion in the study, providing permission for their medical data to be anonymously used for research.
Conflict-of-interest statement: Drs. Landete and González-Rodríguez reports grants from Instituto de Salud Carlos III (ISCIII), grants from Fondo Europeo para el Desarrollo Regional (FEDER, EU), grants from Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), and support from Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas funded by Instituto de Salud Carlos III (ISCIII) and from Scientific Network Enfermedades Metabólicas funded by the Consejo Superior de Investigaciones Científicas (CSIC, Spain), during the conduct of the study.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: All data generated or analysed during this study are included in this published article. Otherwise, the datasets analysed during the current study are available from the corresponding author upon reasonable request.
Corresponding author: Águeda González-Rodríguez, PhD, CSIC Principal Investigator, Ins
Received: December 24, 2025
Revised: February 12, 2026
Accepted: April 8, 2026
Published online: July 21, 2026
Processing time: 195 Days and 0.6 Hours
Revised: February 12, 2026
Accepted: April 8, 2026
Published online: July 21, 2026
Processing time: 195 Days and 0.6 Hours
Core Tip
Core Tip: The non-alcoholic fatty liver disease fibrosis score, a simple non-invasive blood-based algorithm, predicts the presence of subclinical carotid atherosclerosis in patients with obstructive sleep apnea. Importantly, this association is independent of the metabolic dysfunction-associated steatotic liver disease status of the patient, suggesting that non-alcoholic fatty liver disease fibrosis score is an effective, readily available tool for cardiovascular risk stratification in the obstructive sleep apnea population, even in the absence of liver disease.