Prevalence and Risk Factors Associated With Metabolic Dysfunction-Associated Steatotic Liver Disease and Advanced Fibrosis Among Overweight Individuals: Implications for Screening Guidelines.

INTRODUCTION

Current American Association for the Study of Liver Diseases guidelines recommend evaluation for fibrosis in diabetes or medically complicated obesity, and screening for metabolic dysfunction-associated steatotic liver disease (MASLD) in people with cardiometabolic risk factors (CMRFs), but they do not define which metabolic and other risk factors warrant screening in overweight individuals. We aimed to identify risk factors that should prompt liver disease assessment in overweight individuals.

METHODS

This is a cross-sectional analysis of community-dwelling adults (aged 40-75 years) residing in Southern California and enrolled in a prospective study. MASLD was defined as liver fat content ≥5% measured by MRI proton density fat fraction in the absence of other liver diseases and with no or mild alcohol use; advanced fibrosis was defined as ≥3.63 kPa measured by magnetic resonance elastography.

RESULTS

Among 220 overweight individuals (mean age 56.8 ± 9.6 years, 50.9% male), 52% had MASLD, of whom 7% had advanced fibrosis. Hypertriglyceridemia was the strongest independent MASLD predictor (odds ratio [OR] 3.11, 95% CI 1.42-6.81, P = 0.005), followed by hypertension (OR 2.51, 95% CI 1.21-5.23, P = 0.014). For advanced fibrosis, Hispanic ethnicity, diabetes, and low high-density lipoprotein were significant predictors. Notably, 61% of overweight individuals with MASLD did not have diabetes. Targeting overweight individuals with any CMRF for evaluation would identify 93.9% of MASLD cases, compared with only 40.5% when using diabetes alone as the screening trigger.

DISCUSSION: Current guidelines should be expanded to include overweight individuals with any CMRF, not just diabetes, as candidates for Fibrosis-4 Index score assessment. Fibrosis surveillance among overweight individuals should prioritize those with diabetes, as recommended by current guidelines, as well as people of Hispanic ethnicity.