We appreciated the interest in our article1 and the insightful comments from Dr. Enzo Emanuele. We believe that routine use of the proposed NASH scoring system, which comprises variables readily available to clinicians when they evaluate morbidly obese patients, can facilitate clinical decisions and help clinicians choose and tailor treatment for morbid obesity, including bariatric surgery. We agree with Dr. Emanuele that many other biomarkers may indeed increase the diagnostic performance of the proposed NASH scoring system. Further clinical translational research, including cost analysis, is needed to better define diagnostic and therapeutic approaches to obesity and its associated diseases.
Guilherme M. Campos M.D., FACS*, * Department of Surgery, University of California San Francisco, San Francisco, CA.