Metabolic-dysfunction associated steatotic liver disease: clinical features and noninvasive methods of detection in...

Metabolic-dysfunction associated steatotic liver disease (MASLD) is a major cause of liver disease and frequently associated with obesity. This observational study with prospective enrollment aimed to evaluate the clinical and metabolic characteristics of MASLD and to compare the diagnostic accuracy of noninvasive methods versus liver histology in detecting MASLD.

Adults with a BMI > 35 kg/m 2 were enrolled. Data collected included clinical, metabolic, and hepatic parameters, as well as lifestyle and physical examination findings. Liver histology, obtained according to clinical practice, was compared with noninvasive diagnostic tools: Fatty Liver Index (FLI), NAFLD fibrosis score, aspartate aminotransferase/platelet ratio index test, liver elastography, fibrosis-4 index score, and ultrasound imaging.

Ninety-five patients (median age 35 years, predominantly female) were included. Comorbidities were rare. Laboratory results were largely normal, except for elevated insulin and triglyceride levels. Hepatic histology was available in 64 patients (67%). Steatosis was prevalent (84%) with a median score of 2. Ultrasound bright liver patterns and high FLI values (median 98) supported the histological findings. A median Histology Activity Index of 4 and fibrosis stage of 1 indicated mild inflammation and fibrosis, confirmed by noninvasive tests. Multivariate analysis showed a significant linear correlation between FLI and histological steatosis ( P  = 0.001), with FLI being the most accurate non-invasive predictor (area under the receiver operating characteristic: 0.765; P  = 0.001).

In this young with obesity cohort, MASLD was common but with limited liver damage progression. FLI seems to be the best predictor of steatosis. Hypertriglyceridemia and hyperinsulinemia were associated with higher steatosis levels, reflecting the metabolic dysfunction of MASLD.