Screening for MAFLD: who, when and how?

Pal, Shreya C.; Méndez-Sánchez, Nahúm

doi:10.1177/20420188221145650

Cited by 9 publications

(9 citation statements)

References 73 publications

(96 reference statements)

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“…Additionally, we noted that the highest concordance rates (FIB-4/TE vs. FIB-4/LFRI) were shown for results indicating a low ALF risk, which may suggest that the second-level non-invasive tests, such as TE or LFRI, are more consistent in the low-risk assessment for excluding ALF, even in patients with MAFLD. On the contrary, the concordance rates in the intermediate- and high-risk categories were lower, which indirectly supports the recommendation that ALF risk in these groups should be verified by liver biopsy [ 9 , 45 , 46 ]. It should be mentioned that TE may have some limitations and may overestimate the risk of ALF, especially in obese individuals.…”

Section: Discussionsupporting

confidence: 71%

“…Although no universal screening methods have been proposed for MAFLD, all recent international guidelines recommend screening for advanced liver fibrosis (ALF) in suspected subjects [ 6 , 7 , 8 ]. In order to prevent MAFLD progression, the identification of patients at significant risk of ALF should therefore be easier and pursued in the primary care setting [ 3 , 5 , 6 , 7 , 8 , 9 ]. Although liver biopsy is still considered the “gold standard” in evaluating fibrosis severity, non-invasive methods have been proposed for detecting the presence of hepatic fibrosis in suspected MAFLD and also for identifying disease progression.…”

Section: Introductionmentioning

confidence: 99%

“…FIB-4 is a non-invasive scoring system based on four common variables, i.e., age, serum aspartate (AST) and alanine aminotransferase (ALT) activities, and platelet count [ 10 ]. FIB-4 showed an NPV of 90% (by applying a cutoff of <1.3) and a PPV of 80% (by applying a cutoff of >3.25) for ALF [ 9 ]. The major limitation of non-invasive diagnosis of ALF is the suboptimal PPV with a grey zone representing an indeterminate diagnosis of ALF.…”

Section: Introductionmentioning

confidence: 99%

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Performance Evaluation of a Novel Non-Invasive Test for the Detection of Advanced Liver Fibrosis in Metabolic Dysfunction-Associated Fatty Liver Disease

Stefanska,

Bergmann,

Suwała

et al. 2024

Metabolites

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Metabolic dysfunction-associated fatty liver disease (MAFLD) may progress to advanced liver fibrosis (ALF). We evaluated the diagnostic accuracy of a novel Liver Fibrosis Risk Index (LFRI) in MAFLD subjects using transient elastography (TE) as the reference method for liver fibrosis measurement and then the diagnostic performance of a new two-step non-invasive algorithm for the detection of ALF risk in MAFLD, using Fibrosis-4 (FIB-4) followed by LFRI and comparing it to the reference algorithm based on FIB-4 and TE. We conducted a prospective study on 104 MAFLD European adult subjects. All consenting subjects underwent TE and measurements of FIB-4 and LFRI. For FIB-4 and TE, validated cut-offs were used. An ROC analysis showed that LFRI diagnosed severe fibrosis with moderate accuracy in MAFLD subjects with a negative predictive value above 90%. Using the new algorithm with LFRI thresholds recommended by the manufacturer, the number of subjects classified into ALF risk groups (low, intermediate, or high) differed significantly when compared with the reference algorithm (p = 0.001), with moderate agreement between them (weighted kappa (95% CI) = 0.59 (0.41–0.77)). To improve the performance of the LFRI-based algorithm, we modified cut-off points based on ROC curves obtained by dividing the study population according to the reference algorithm and observed no difference between algorithms (p = 0.054) in categorizing ALF risk, with a slight increase in the total agreement (weighted kappa (95% CI) = 0.63 (0.44–0.82)). Our findings suggest that using the novel LFRI as a second-line test may represent a potential alternative for liver fibrosis risk stratification in MAFLD patients; however, modified cut-offs are needed to optimize its performance.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Performance Evaluation of a Novel Non-Invasive Test for the Detection of Advanced Liver Fibrosis in Metabolic Dysfunction-Associated Fatty Liver Disease

Stefanska,

Bergmann,

Suwała

et al. 2024

Metabolites

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“…Since MAFLD frequently exhibits no noticeable symptoms until reaching more advanced stages, the need for early detection and screening for this condition, along with its primary prognostic indicator (i.e., liver fibrosis), is becoming increasingly vital. [ 16 ] To address this growing concern, in the present study, we proposed to integrate opportunistic screening initiatives within the scope of family medicine practices. This is particularly relevant considering the general population’s limited awareness of this condition, coupled with the persistent rise in the prevalence of metabolic diseases.…”

Section: Discussionmentioning

confidence: 99%

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

Yılmaz¹

2024

Hepatology Forum

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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.

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“…Due to the above and because performing a biopsy is not free of complications, some non-invasive tests have been developed and validated [8]. Among the imaging studies for detecting liver steatosis is ultrasound, which offers a sensitivity of 67-94% and a specificity of up to 97% [9]. Computed tomography has a sensitivity of 82% and a specificity of 100% to detect liver steatosis when the fat content is greater than or equal to 30%.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of the Triglyceride–Glucose Index (TyG), TyG Body Mass Index, and TyG Waist Circumference Index for Liver Steatosis Detection

Mijangos-Trejo,

Gómez-Mendoza,

Ramos-Ostos

et al. 2024

Diagnostics

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Background: The triglyceride–glucose index (TyG) and a combination of body mass index (BMI) and waist circumference (WC) have been proposed as predictive scores for liver steatosis (LS). The aim of this study was to determine the diagnostic accuracy of these indices compared with controlled attenuation parameters (CAPs) and other predictive scores of LS. Methods: A retrospective analysis of patients who attended a check-up unit in 2021 was performed. LS was determined by CAP. Anthropometric and biochemical parameters for calculating TyG, TyG-BMI, TyG-WC, fatty liver index, and hepatic steatosis index were obtained. ROC curve was used to establish the best cut-off point of each TyG index for LS detection. The accuracy was determined for all patients, as well as for overweight and diabetic patients. Results: Medical records of 855 patients with a median age of 48 [IQR, 44–54] years and a BMI of 25.7 [IQR 23.4–28.1] kg/m2 were included. According to CAP, LS prevalence was 31.8% (n = 272). TyG-BMI and TyG-WC show better AUCs compared with CAP (0.82, 0.81), FLI (0.96, both), and HSI (0.93, 0.85). For diabetic patients, TyG-WC shows an AUC of 0.70. Meanwhile, TyG-BMI shows better accuracy (0.75) compared with CAP. Conclusions: TyG-BMI and TyG-WC showed a superior predictive accuracy for detecting LS compared with the TyG index.

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Screening for MAFLD: who, when and how?

Cited by 9 publications

References 73 publications

Performance Evaluation of a Novel Non-Invasive Test for the Detection of Advanced Liver Fibrosis in Metabolic Dysfunction-Associated Fatty Liver Disease

Performance Evaluation of a Novel Non-Invasive Test for the Detection of Advanced Liver Fibrosis in Metabolic Dysfunction-Associated Fatty Liver Disease

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

Diagnostic Accuracy of the Triglyceride–Glucose Index (TyG), TyG Body Mass Index, and TyG Waist Circumference Index for Liver Steatosis Detection

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