The edition · Internal Medicine
Most routine blood tests need no fast, and which fatty-liver score earns a repeat look
Nearly 10 million results from one Korean hospital found fasting mattered for only a handful of analytes, and fasting past 12 hours changed none. In 853,131 veterans with steatotic liver, the SAFE score best flagged who to re-screen for cirrhosis.
The edition in brief
In nearly 9.8 million results from 101,148 outpatients across 372 tests at one Korean hospital, fasting under 8 hours raised glucose (10.8%), triglycerides (20.1%), GGT (14.8%) and lipase (36.4%) beyond analytical tolerances in within-person comparisons; most other analytes were unaffected, and fasting more than 12 hours changed nothing compared with 8–12 hours. In 853,131 US veterans with steatotic liver disease and no cirrhosis, FIB-4, APRI and SAFE best discriminated 10-year cirrhosis risk, SAFE gave the most net benefit, and no score was useful for deciding on liver cancer screening. A target-trial emulation in 2,737 women with vasomotor symptoms linked starting menopausal hormone therapy with lower cardiovascular risk (aHR 0.78), mainly when begun within 10 years of menopause; the authors warn against using it for prevention. In 597,430 US nursing home residents, RSV vaccination was associated with 73% fewer RSV hospitalisations. The pearl covers the age traps in FIB-4.
SAFE score best identified who with fatty liver to re-screen for cirrhosis
In fatty liver without cirrhosis, use a blood-based fibrosis score to decide who needs further assessment; scores do not justify liver cancer surveillance.
Hormone therapy started near menopause was linked to lower cardiovascular risk in women with hot flushes
For women with hot flushes within 10 years of menopause, these data are reassuring about cardiovascular risk; they are not a reason to prescribe for prevention.
RSV vaccination was linked to 73% fewer RSV hospitalisations in nursing home residents
RSV vaccination was associated with substantially fewer hospitalisations and deaths in nursing home residents; consider it for frail older adults where available.
FIB-4 has two age traps
Adjust the FIB-4 cut-off upward for over-65s and do not rely on it under 35.
Fasting changed only a few routine blood tests, and fasting beyond 12 hours changed none
Ask patients to fast only for tests where it matters — mainly glucose, triglycerides, GGT and lipase — and never beyond 12 hours.
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