Vibration-Controlled Transient Elastography-Based Prevalence of Metabolic Dysfunction-Associated Steatotic Liver Disease in Saudi Arabia: A Prospective Cohort Study.

BACKGROUND & AIMS: Metabolic dysfunction-associated steatotic liver disease is the most common chronic liver disease worldwide. We aimed to estimate the prevalence, severity, and metabolic determinants of metabolic dysfunction-associated steatotic liver disease and liver fibrosis among Saudi adults using vibration-controlled transient elastography.

METHODS

We conducted a cross-sectional analysis from the prospective, population-based Genomics and Environmental Noninvasive Evaluation for Saudi Intrahepatic Steatosis (GENESIS) cohort across 7 primary care centers in Saudi Arabia between March 2024 and June 2025. Eligible adults underwent clinical assessment, laboratory testing, and vibration-controlled transient elastography. We defined metabolic dysfunction-associated steatotic liver disease as controlled attenuation parameter ≥268 dB/m with ≥1 cardiometabolic risk factor, and significant fibrosis as liver stiffness measurement ≥8 kPa.

RESULTS

Among 2979 participants included in the analytic cohort (mean age, 41.9 years; 49.7% men), 1111 met metabolic dysfunction-associated steatotic liver disease criteria, yielding a crude prevalence of 37.3% (95% confidence interval, 35.6%-39.0%) and an age- and sex-adjusted prevalence of 34.2% (95% confidence interval, 32.5%-35.9%). Forty-eight (4.3%) participants with metabolic dysfunction-associated steatotic liver disease had significant fibrosis. Diabetes (odds ratio, 1.80; 95% confidence interval, 1.43-2.27), waist circumference (odds ratio, 1.35; 95% confidence interval, 1.30-1.40), and high obstructive sleep apnea risk (odds ratio, 1.47; 95% confidence interval, 1.21-1.80) were independently associated with metabolic dysfunction-associated steatotic liver disease. Diabetes (odds ratio, 4.41; 95% confidence interval, 2.12-9.14), male sex (odds ratio, 2.83; 95% confidence interval, 1.31-6.13), and waist circumference (odds ratio, 1.24; 95% confidence interval, 1.11-1.39) were independently associated with significant fibrosis among individuals with metabolic dysfunction-associated steatotic liver disease.

CONCLUSIONS

Metabolic dysfunction-associated steatotic liver disease affects more than one-third of Saudi adults and is associated with central obesity and metabolic dysfunction, whereas significant fibrosis remains relatively low. These findings provide the first prospective, population-level metabolic dysfunction-associated steatotic liver disease estimates at a country level in Saudi Arabia and support scalable vibration-controlled transient elastography-based risk stratification.