Prevalence, determinants, and fibrosis risk stratification of metabolic-associated fatty liver disease in a Turkish primary care setting: A retrospective study

Abstract

Background and Aim: Metabolic-associated fatty liver disease (MAFLD) is a condition that frequently goes unnoticed as it typically remains asymptomatic until progressing to an advanced stage. As a result, it is essential to implement opportunistic screening initiatives within family medicine practices to accurately identify and refer selected at-risk patients to specialized care. This study aims to investigate the prevalence of MAFLD and advanced hepatic fibrosis among primary care patients in Turkiye by utilizing non-invasive tests. Materials and Methods:We performed a retrospective analysis of prospectively collected data from February 1, 2022, to April 14, 2023, at a Family Medicine Outpatient Clinic. The Hepatic Steatosis Index (HSI) was used to identify fatty liver cases, followed by established MAFLD criteria for diagnosis. Patients were then categorized based on advanced fibrosis risk using the fibrosis-4 (FIB-4) index.Results: Among the 450 patients who sought primary care during the study period (286 women and 164 men; mean age: 48.2±13.7 years), 295 (65.6%) were diagnosed with MAFLD using HSI values and established criteria. Diabetes mellitus emerged as the sole independent predictor of MAFLD. FIB-4 values classified 242 (82%) and 53 (18%) patients with MAFLD at low and intermediate risk of advanced fibrosis, respectively, with none at high risk. Conclusion:MAFLD exhibits a notable prevalence among Turkish patients who presented at a Family Medicine Outpatient Clinic. Given the growing impact of metabolic diseases, primary care providers and non-liver specialists should actively participate in MAFLD screening programs.

Fatty liver biomarkers and insulin resistance indices in the prediction of non‐alcoholic fatty liver disease in Ghanaian patients

“…Postulated to be driven by insulin resistance among other things, 24 the relationship between fatty liver and obesity has been continually reaffirmed 25,26 . Despite the relationship between FPG and NAFLD, diabetes mellitus was not found to be a predictor of steatosis in our patient cohort, which is at variance with that of a Turkish study 27 . This might have to do with the common use of medication such a metformin and pioglitazone among diabetics which are known to affect fatty liver.…”

“…25,26 Despite the relationship between FPG and NAFLD, diabetes mellitus was not found to be a predictor of steatosis in our patient cohort, which is at variance with that of a Turkish study. 27 This might have to do with the common use of medication such a metformin and pioglitazone among diabetics which are known to affect fatty liver. Our work found a significant association between NAFLD and the anthropometric measurements we assessed, which included BMI, WtH and WHtR.…”

Suboptimal reliability of FIB‐4 and NAFLD‐fibrosis scores for staging of liver fibrosis in general population

“…7 Similarly, retrospective studies on patients with NAFLD and metabolic-associated fatty liver disease (MAFLD) have shown that FIB-4 and NFS classify individuals as low risk for advanced fibrosis. 8,9 Furthermore, Thévenot et al investigated noninvasive tests (NITs) for screening advanced liver fibrosis in 189 patients with coronary artery disease and NAFLD. Their findings suggested that NFS or the easy liver fibrosis test (eLIFT) were the most promising first-line biochemical NITs for identifying suitable candidates for Fibroscan.…”

“…In a prospective study involving 81 patients with biopsy‐proven advanced fibrosis, the FIB‐4 score and NFS effectively ruled out advanced fibrosis, resulting in a 67% reduction in the necessity for biopsies 7 . Similarly, retrospective studies on patients with NAFLD and metabolic‐associated fatty liver disease (MAFLD) have shown that FIB‐4 and NFS classify individuals as low risk for advanced fibrosis 8,9 …”