Association of serum trace elements with non-invasive fibrosis scores in metabolic dysfunction-associated steatotic liver disease

Liver biopsy is not a routine screening tool for detecting fibrosis progression in metabolic dysfunction-associated steatotic liver disease (MASLD). Noninvasive methods based on serum biomarkers are used instead. This study evaluated the relationship between serum zinc (Zn), copper (Cu), and ceruloplasmin levels and non-invasive criteria for hepatic fibrosis, including Fibrosis-4 (FIB-4), Nonalcoholic Fatty Liver Disease fibrosis score (NFS), and BARD, in patients with MASLD. In this prospective cross-sectional study, a total of 134 MASLD patients referred to the gastroenterology clinic of Imam Reza Hospital and Sheikh AlRaees Clinic, Tabriz, in 2022 were included. Serum levels of Zn, Cu, ceruloplasmin, albumin, complete blood count (CBC), fasting blood sugar (FBS), Alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were checked. Also, non-invasive measures of FIB-4, NFS, and BARD were measured. Finally, the relationship between the levels of Zn, Cu, and ceruloplasmin with each of the FIB-4, NFS, and BARD criteria was investigated. Zn serum levels were significantly lower in FIB-4 3 than in FIB-4 1 and 2 (P-value < 0.01); however, no significant relationship was found between serum Cu and ceruloplasmin variables with FIB-4 (P > 0.05). Zn serum levels were also significantly higher in NFS fibrosis score 1 (P-value < 0.01). There was no significant relationship between serum Cu and ceruloplasmin variables with NFS fibrosis score in the studied patients (P > 0.05). No significant relationship was observed between serum Zn, Cu, and ceruloplasmin with the BARD fibrosis score in the studied patients (P > 0.05). It seems that among the levels of Zn, Cu, and ceruloplasmin serum with non-invasive measures of liver fibrosis, including FIB-4, NFS, and BARD in MASLD patients, there is only a significant relationship between serum Zn level and FIB-4 and NFS criteria. And therefore, Zn may serve as a potential biomarker.