Improving MASLD Risk Stratification in Young Adults with Cardiometabolic Risk Factors and Insulin Resistance...

Area of Science:

• Hepatology
• Cardiology
• Endocrinology

Background:

• The fibrosis-4 index (FIB-4) is recommended for identifying significant fibrosis in adults with metabolic dysfunction-associated steatotic liver disease (MASLD).
• FIB-4's reliability is reduced in younger adults (under 45 years).
• Cardiometabolic risk factors (CMRFs) and insulin resistance (IR) are common in MASLD.

Purpose of the Study:

• To evaluate if CMRFs or IR enhance MASLD fibrosis risk stratification in young adults.
• To compare the diagnostic performance of FIB-4, CMRFs, and IR in young adults with MASLD.

Main Methods:

• Adults screened for significant liver fibrosis (≥F2) using vibration-controlled transient elastography.
• Magnetic resonance elastography or liver biopsy used for diagnosis confirmation.
• Analysis included assessment of FIB-4 index, CMRFs (type 2 diabetes, hypertension, obesity), and homeostatic model assessment of insulin resistance (HOMA-IR).

Main Results:

• In young adults, absence of CMRFs or IR indicated a low likelihood of significant fibrosis (NPV 97-100%).
• FIB-4 index showed low sensitivity (15%) but high specificity (97%) for significant fibrosis in young adults.
• Combining CMRFs with HOMA-IR improved risk stratification compared to CMRFs alone (sensitivity 75% to 78%, specificity 75% to 81%).

Conclusions:

• In young adults, the absence of CMRFs or IR suggests clinically significant fibrosis is unlikely.
• Measuring IR improves risk stratification when CMRFs are present in young adults.
• Combining CMRFs with IR may enhance the detection of significant liver fibrosis in younger populations.