Predictors of Hepatic Steatosis and the Limitations of the FIB-4 Index in Type 2 Diabetes: A Cross-Sectional Study

Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among patients with type 2 diabetes mellitus (T2DM). Non-invasive tools (NITs) such as the FIB-4 index, are widely used for risk stratification to identify patients at higher risk of progressive liver disease. This study aimed to assess the utility of the FIB-4 index and identify stronger predictors of MASLD in a T2DM cohort.

A retrospective cross-sectional study was conducted on 186 patients with T2DM. Hepatic steatosis was diagnosed via abdominal ultrasonography, categorizing patients into MASLD (n=100) and non-MASLD (n=86) groups. The FIB-4 index was calculated, and group comparisons were performed. A novel simplified clinical scoring system was constructed to identify independent predictors of ultrasound-confirmed steatosis.

Patients with MASLD exhibited significantly higher body mass index (BMI) (P < 0.001), alanine aminotransferase (ALT) (P = 0.005), Aspartate aminotransferase (AST) (P =0.05) and triglycerides (P = 0.034) compared to the non-MASLD group. The multivariate logistic regression analysis established the weight of each clinical marker. The FIB-4 index failed to significantly differentiate between the two groups (P = 0.272).

The FIB-4 index demonstrated limited diagnostic utility for MASLD in this T2DM population. Conversely, a newly derived score, incorporating readily available parameters like BMI, ALT, AST, and triglycerides, offers a highly specific, practical alternative for non-invasive MASLD screening in resource-limited primary care settings.