Screening for Hepatic Steatosis and Fibrosis Among Physicians Attending the Integrated Diabetes and Endocrine Academy...

Introduction Metabolic dysfunction-associated steatotic liver disease (MASLD) is commonly detected using the Fibrosis-4 (FIB-4) score, a non-invasive tool for advanced fibrosis, though its screening utility in this specific population remains uncertain. Transient elastography (FibroScan) measures steatosis using the controlled attenuation parameter (CAP) and fibrosis using liver stiffness measurement (LSM), both of which remain underexplored in metabolic diseases. This study evaluated the effectiveness of FIB-4 in screening for advanced hepatic fibrosis 3 (F3) and advanced hepatic fibrosis 4 (F4) in physicians with generalised or central obesity. Methods Physicians (n = 162) at the Integrated Diabetes and Endocrine Academy Conference (IDEACON) were assessed for demographics (age, sex), anthropometrics (height, body mass index (BMI), waist circumference (WC)), laboratory parameters (alanine aminotransferase (ALT), aspartate aminotransferase (AST), glycated haemoglobin (HbA1c), platelet count), and FIB-4. CAP and LSM were measured using FibroScan, and the diagnostic performance of FIB-4 was evaluated against CAP and LSM-defined outcomes for hepatic steatosis and fibrosis. Results The mean age of the participants was 46.0 years, and 86.3% were male. The mean BMI was 27.6 kg/m², and the prevalence of type 2 diabetes mellitus (T2DM) was 28.6%. FIB-4 showed poor sensitivity (6.3% for LSM F3/F4 and 5.1% for stage 3 (S3) fibrosis) and area under the curves (AUCs) (0.51, 0.49), despite high specificity (95.7%). Multivariate analysis identified WC (OR = 1.09, p = 0.036) and ALT (OR = 1.05, p = 0.013) as predictors of CAP S3, age (OR = 1.16, p = 0.021) for LSM F3, and T2DM (OR = 33.34, p = 0.010) for LSM F4. Obese participants (88.8%) had higher CAP S3 (25.7%) and LSM F3/F4 (18.1%). Conclusion FIB-4 is inadequate for screening hepatic fibrosis in physicians. Combined CAP and LSM assessment is essential for at-risk individuals with obesity and increased WC.