Fibrosis-4 and Ultrasonography Assessment of Metabolic Dysfunction-associated Steatotic Liver Disease: A Cross-sectional, Observational Study

A BSTRACT Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed nonalcoholic fatty liver disease, has now emerged as endemic. Fibrosis-4 (FIB-4) can grade the risk of evolving liver fibrosis utilizing inexpensive easily available parameters, and ultrasonography (USG) is the attainable initial imaging modality to detect the presence of MASLD. This study aimed to determine the prevalence and grades of MASLD along with fibrosis risk stratifications according to the FIB-4 index among the urban diabetic population of Bangladesh. Methods: This cross-sectional observational study was performed at National Healthcare Network Uttara, Dhaka, Bangladesh, from November 2022 to October 2023 with ethical clearance among nonpregnant adults having type 2 diabetes mellitus, aged 18 years to ≤74 years. The presence of MASLD with grading was ascertained by USG of the hepatobiliary system, and the fibrosis risk score was calculated according to the FIB-4 index. Results: Overall, 167 subjects were studied (male-to-female ratio of 1:1.7). USG revealed that 94.6% had fatty changes in the liver, among them 37.7% had Grade 1, 48.5% had Grade 2, and 8.4% had Grade 3 fatty changes. Risk stratification by the FIB-4 index revealed that 65.3% had low risk, 31.7% indeterminate risk, and 3.0% high risk for hepatic fibrosis. Most subjects in the indeterminate and high-risk group had HbA1c% ≥7 than the low-risk group for fibrosis. The study found that 41.9% of patients were overweight, 47.3% were obese, and central abdominal obesity was seen in 85.6% of patients. Conclusion: This study revealed a considerable prevalence of MASLD, with varying degrees of liver fibrosis among the diabetic population. Case-finding strategies using USG and noninvasive tests (such as FIB-4) should be applied to rule out or in advanced fibrosis.