Time to Screen for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): Insights From a Single-Center...

Area of Science:

• Hepatology
• Primary Care Medicine
• Diagnostic Tools

Background:

• Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent cause of chronic liver disease globally, strongly linked to obesity and type 2 diabetes.
• Many MASLD patients are undiagnosed in primary care due to normal liver enzyme levels, masking significant fibrosis.
• Noninvasive fibrosis scores like FIB-4 are recommended for risk stratification in current guidelines.

Purpose of the Study:

• To evaluate fibrosis risk in primary care patients with normal liver enzymes and metabolic risk factors.
• To assess referral patterns to gastroenterology services for MASLD patients.
• To provide real-world evidence from Saudi Arabia on noninvasive fibrosis risk stratification in primary care.

Main Methods:

• Retrospective observational study using electronic medical records from Saudi Arabian primary care clinics (January 2021 - December 2024).
• Included 200 adult patients with metabolic risk factors (obesity, type 2 diabetes) and normal liver enzymes.
• Calculated FIB-4 scores to categorize patients into low, intermediate, and high fibrosis risk.

Main Results:

• A significant proportion of patients with normal liver enzymes showed intermediate or high fibrosis risk via FIB-4 scores.
• Referral rates to gastroenterology were low, indicating missed opportunities for early detection.
• Integration of FIB-4 into primary care pathways could enhance early identification and referral for MASLD patients.

Conclusions:

• Proactive screening is vital for high-risk individuals, even with normal liver enzymes, as biochemistry alone may miss significant fibrosis.
• Utilizing tools like FIB-4 and AST:ALT ratio aids in earlier identification of MASLD.
• Timely intervention is facilitated by earlier detection of advanced fibrosis.