S2453 BMI-Stratified Metabolic Profile of Metabolic Dysfunction-Associated Steatotic Liver Disease in a South Indian Population

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common cause of end stage liver disease worldwide. MASLD is commonly associated with obesity and dyslipidemia, however less studied so called “lean” phenotypes do exist and are particularly prevalent in certain Asian populations. This study aims to evaluate the metabolic differences between patients with MASLD in different body mass index (BMI) groups. Methods: Patients availing the health checkup service of a tertiary care center were enrolled. A total of 3 groups were made consisting of lean (BMI <23 kg/m2), overweight (BMI between 23 kg/m2 and 25 kg/m2) and obese (BMI ≥25 kg/m2) patients. Patients with MASLD in each BMI strata were considered cases and were compared to controls, consisting of patients without MASLD in the same BMI strata. The metabolic profile consisting of lipid profile, liver function tests, serum creatinine, serum uric acid and fasting blood sugar (FBS) was done for each patient and values were compared between all groups. Presence of diabetes was also compared between groups. Results: A total of 173 patients were enrolled, of which 49 were lean, 65 were overweight and 59 were obese. Lean patients with MASLD showed no significant differences in their metabolic profile in comparison to lean patients without MASLD. Interestingly, lean MASLD patients had the highest mean uric acid levels (6.52 mg/dL), highlighting a distinct metabolic profile. Overweight patients with MASLD showed increased levels of serum cholesterol (P = 0.001), LDL (P = 0.025), ALT (P = 0.008), GGT (P = 0.044), globulin (P = 0.031) and fasting blood sugar (P = 0.026) when compared to their counterparts without MASLD. In obese patients, the presence of MASLD heralded an increased FBS (P = 0.048). There was no significant difference in the presence of diabetes between groups (P = 0.17). Conclusion: In our study, lean MASLD did not show any differences in serum values of lipid or liver enzymes, which may imply a slightly different pathway of causation of MASLD in this group. In contrast, overweight and obese patients with MASLD showed clear lipid, metabolic and hepatic derangements which supports existing models of MASLD causation. Curiously, metabolic derangements were more profound in the overweight group and were more strongly associated with MASLD in the same. The etiology for this disparity is uncertain and may be confounded by the lower accuracy of noninvasive MASLD detection in obese individuals.