The paradox of high metabolic risk and low FIB-4 scores in the elderly: a nationwide community-based analysis (DAHUDER geriatric MASLD study)

This study aimed to determine the prevalence of metabolic dysfunction–associated steatotic liver disease (MASLD) in community-dwelling Turkish adults aged ≥ 65 years with at least one cardiometabolic risk factor (CMRF) and to identify risk factors associated with liver fibrosis. This nationwide study is a retrospective cross-sectional analysis of prospectively collected data from 31 cities and 44 internal medicine outpatient clinics representing all statistical regions of Türkiye. A total of 2613 older individuals (mean age 71.55 ± 5.40, 62.8% female) were enrolled in the study. The prevalence of MASLD ( N = 1811) and high FIB-4 ( N = 412) was 69.3% and 15.8% in the all patient group, respectively. The mean FIB-4 score was significantly lower in MASLD group ( P < 0.001). The prevalence of smoking (8.7%, P = 0.034), type 2 diabetes mellitus (T2DM) (54.4%, P < 0.001), metabolic syndrome (83.7%, P < 0.001), obesity (42.2%, P = 0.004), dyslipidemia (45.6%, P = 0.001) and MASLD (59.2%, P < 0.001) was found to be lower in the high FIB-4 group. Moreover, the prevalence of high FIB-4 progressively decreased with the number of CMRFs, ranging from 35.9% in participants with one factor to 13.3% in those with all five factors. In the multivariable regression analysis; female sex [OR: 0.763, (95%CI: 0.605–0.961); ( P = 0.022), smoking [0.610, (95%CI: 0.419–0.889); ( P = 0.010)], T2DM [OR: 0.722, (95%CI: 0.575–0.905); P = 0.005], MASLD [OR: 0.671, (95%CI: 0.533–0.844); ( P = 0.001)] were independently and negatively associated with high FIB-4 score. Despite high MASLD prevalence in older Turkish adults, the FIB-4 score negatively correlates with CMRFs, rendering it unreliable. These findings suggest that FIB-4 may be driven by age and age-related changes rather than liver pathology in this population, significantly limiting its utility as a screening tool in geriatric care.

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Journal
Diabetology & Metabolic Syndrome
Published
2026-11-06
DOI
https://doi.org/10.1186/s13098-026-02331-9
Primary Topic
Liver Disease Diagnosis and Treatment
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article
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article

The paradox of high metabolic risk and low FIB-4 scores in the elderly: a nationwide community-based analysis (DAHUDER geriatric MASLD study)

Hilmi Erdem Sümbül, Bahri Abaylı, Hikmet Öztop, Tuba Taslamacıoğlu Duman et al.
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Diabetology & Metabolic Syndrome
Liver Disease Diagnosis and Treatment
article

The paradox of high metabolic risk and low FIB-4 scores in the elderly: a nationwide community-based analysis (DAHUDER geriatric MASLD study)

Hilmi Erdem Sümbül, Bahri Abaylı, Hikmet Öztop, Tuba Taslamacıoğlu Duman, Hasan Sözel, Türkan Paşalı Kilit, Nevzat Gözel, Melis Gökgöz, Sami Bahçebaşı, Ömer Faruk Alakuş, Kubilay İşsever, Deniz Çekiç, İsmail Demir, Oktay Olmuşçelik, Celalettin Küçük, Süleyman Emre Koçyiğit, Ayşe Kevser Demir, Fatih Atik, İsmail Kırlı, Selçuk Yaylacı, Muharrem Bayrak, Oğuzhan Zengin, Müzeyyen Eryılmaz, Hakan Şıvgın, Emin Gemcioğlu, İhsan Solmaz, Erkan Dulkadiroğlu, Enes Seyda Şahiner, Betül Erişmiş, Ülfet Değer, Osman Özüdoğru, Mehmet Selim Mamiş, Berrin Aksakal, Eşref Araç, Ahmet Veli ŞANİBAŞ, Hasan Esat Yücel, Elif Duygu Topan, Nur Düzen Oflas, Sanem Kayhan, Hatice Özge Serin, Alihan Oral, Hilal Bektaş Uysal, Hatice Beyazal Polat, Cem Şahin, Melisa Şahin Tekin, Özge Kurtkulağı, Sıbel Ocak Serın, Fatih Kamış, Mehmet Serdar Yıldırım, Feride Çağlar, Gökhan Tazegül, Seyit Uyar, Oğuzhan Sıtkı Dizdar, Ali Kırık, Ensar Özmen, Necip Nas, Yasin Şahintürk, Bilgin Bahadır Başgöz, İrem Biçer, Muhammet Özbilen, Gülali Aktaş, Erkan Çakmak, Hasan Tunca, Lale Saka Baraz, Orhan Balıkçı, Ali Zeynettin, Nazif Yalçın, Rıfat Bozkuş, Uğur Can İzlimek, Ahmet Aydın, Hasan Esat Yıldırım, Sibel Demiral Sezer, Pınar Yıldız, Canan Akkuş, Ahmed Bilal Genç, Alı Erol, Fatih Coşkun, Hüseyin Ali Öztürk, Erkan Özdemir, Hatice Metin, Kamil Konur, Emine Binnetoglu, Ayşegül Ertınmaz, Mert Akyıldız, Cüneyt Çağatay, Aynur Kamburoğlu, Yusuf Kimyon, Nizameddin Koca, Ece Ünal Çetin, Emel Sağlam, Hale Akan, Selin Müge Aslan, Abdullah Tanrıkulu, Fatih İleri, Şeref Enes Kocaman, Huseyin Yildiz, Özge Kama Başçı, Burçin Meryem Atak Tel, Demet Yalçın Kehribar, Hacer Şen
article en

Abstract

This study aimed to determine the prevalence of metabolic dysfunction–associated steatotic liver disease (MASLD) in community-dwelling Turkish adults aged ≥ 65 years with at least one cardiometabolic risk factor (CMRF) and to identify risk factors associated with liver fibrosis. This nationwide study is a retrospective cross-sectional analysis of prospectively collected data from 31 cities and 44 internal medicine outpatient clinics representing all statistical regions of Türkiye. A total of 2613 older individuals (mean age 71.55 ± 5.40, 62.8% female) were enrolled in the study. The prevalence of MASLD ( N = 1811) and high FIB-4 ( N = 412) was 69.3% and 15.8% in the all patient group, respectively. The mean FIB-4 score was significantly lower in MASLD group ( P < 0.001). The prevalence of smoking (8.7%, P = 0.034), type 2 diabetes mellitus (T2DM) (54.4%, P < 0.001), metabolic syndrome (83.7%, P < 0.001), obesity (42.2%, P = 0.004), dyslipidemia (45.6%, P = 0.001) and MASLD (59.2%, P < 0.001) was found to be lower in the high FIB-4 group. Moreover, the prevalence of high FIB-4 progressively decreased with the number of CMRFs, ranging from 35.9% in participants with one factor to 13.3% in those with all five factors. In the multivariable regression analysis; female sex [OR: 0.763, (95%CI: 0.605–0.961); ( P = 0.022), smoking [0.610, (95%CI: 0.419–0.889); ( P = 0.010)], T2DM [OR: 0.722, (95%CI: 0.575–0.905); P = 0.005], MASLD [OR: 0.671, (95%CI: 0.533–0.844); ( P = 0.001)] were independently and negatively associated with high FIB-4 score. Despite high MASLD prevalence in older Turkish adults, the FIB-4 score negatively correlates with CMRFs, rendering it unreliable. These findings suggest that FIB-4 may be driven by age and age-related changes rather than liver pathology in this population, significantly limiting its utility as a screening tool in geriatric care.

Diabetology & Metabolic Syndrome
Sakarya University (TR), Balıkesir University (TR), Çanakkale Onsekiz Mart Üniversitesi (TR), Van Yüzüncü Yıl Üniversitesi (TR), Dicle University (TR), Bursa Uludağ Üni̇versi̇tesi̇ (TR), Fırat University (TR), Giresun University (TR), Siirt Üniversitesi (TR), Recep Tayyip Erdoğan University (TR), Dokuz Eylül University (TR), Akdeniz University (TR), Ahi Evran University (TR), Tokat Gaziosmanpaşa Üniversitesi (TR), Istanbul Medipol University (TR), Biruni University (TR), Marmara Üniversitesi Eğitim ve Araştırma Hastanesi (TR), Akdeniz University Hospital (TR), Antalya Eğitim ve Araştırma Hastanesi (TR), Ümraniye Eğitim ve Araştırma Hastanesi (TR), Bağcılar Eğitim ve Araştırma Hastanesi (TR), Samsun University (TR), Kayseri Eğitim ve Araştırma Hastanesi (TR), Sağlık Bilimleri Üniversitesi (TR), Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi (TR), Malatya Devlet Hastanesi (TR), Fatih Sultan Mehmet Eğitim Ve Araştırma Hastanesi (TR), S.B.Ü. Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi (TR), Kutahya Saglik Bilimleri Universitesi (TR), Seyhan Devlet Hastanesi (TR), Ankara Bilkent City Hospital (TR), İzmir Şehir Hastanesi (TR), Ankara Etlik City Hospital (TR), Bursa City Hospital (TR), Ankara Eğitim ve Araştırma Hastanesi (TR), Eskişehir Osmangazi University (TR), Gaziantep University (TR), Ordu University (TR), Marmara University (TR), Adnan Menderes University (TR), Bolu Abant İzzet Baysal University (TR), Muğla University (TR)
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Liver Disease Diagnosis and Treatment
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