Peri-Complication Diagnosis of Nonalcoholic Fatty Liver Disease: A US Population-Based Retrospective Analysis

Screening guidelines for nonalcoholic fatty liver disease, now called metabolic dysfunction-associated steatotic liver disease (MASLD), remain controversial, though early diagnosis can faciliate intervention and prevention.

A retrospective analysis of adult patients within the Merative™ Marketscan® Databases (1/2007-12/2021) with a diagnosis of MASLD, a liver complication (defined as HCC, cirrhosis with or without evidence of portal hypertension such as varices, ascites, and hepatic encephalopathy or liver transplant), and ≥12 months of insurance coverage prior to the first liver complication.

We analyzed 143,310 patients meeting inclusion criteria. The majority (95,843, 66.8%, p < 0.001) had a pericomplication diagnosis of MASLD. Compared to patients without delayed diagnosis, those with a pericomplication diagnosis were older (57.6 ± 14.5 vs. 53.8 ± 12.5), more likely to have used tobacco (18.7% vs. 12.6%) and illicit drugs (2.3% vs. 1.4%), metabolic diseases, and higher mean Charlson Comorbidity Index (CCI, 3.0 ± 3.0 vs. 1.9 ± 2.3), all p < 0.0001. On multivariable logistic regression adjusted for age, sex, and CCI, a first visit with gastroenterology (odds ratio [OR] 0.32, 95% CI 0.31-0.32, p < 0.001), or a specialist seeing patients with metabolic disease (cardiology, endocrinology, or nephrology) (OR 0.44, 95% CI 0.43-0.45, p < 0.001) more than 12 months prior to a complication was associated with significantly lower odds of delayed diagnosis of MASLD.

Diagnosis of MASLD in real-world patients is severely delayed, with 2 in 3 patients diagnosed either after or within 6 months from a liver complication. Patients followed longitudinally by medical providers in gastroenterology and other metabolic specialties had a substantially lower risk of an early complication.