NAFLD becomes MASLD, frequency & characteristics of non obese metabolic dysfunction associated steatotic liver disease (MASLD) among patients seeking care at a tertiary medical facility

Abstract

Objective: To determine the frequency and clinical characteristics of non-obese metabolic dysfunction-associated steatotic liver disease, distinguishing it from simple steatosis without metabolic dysfunction.

Method: The cross-sectional, observational study was conducted at Indus Hospital Karachi, Pakistan from October 2021 to March 2022, and comprised adult patients of either gender with hepatic steatosis confirmed by abdominal ultrasonography. Body mass index of each patient was classified as per the Asia-Pacific cut-offs. Metabolic dysfunction-associated steatotic liver disease was diagnosed on the basis of the presence of hepatic steatosis with at least one cardiometabolic risk factor. Physical activity levels of the subjects were assessed using the World Health Organisation guidelines. Data was analysed using SPSS 26.

Results: Of the 158 patients, 112(70.9%) were female and 46(29.1%) were male. The overall median age was 49 years (interquartile range: 40.5-58 years). Of the total, 30(19%) patients were classified as non-obese, and 128(81%) as obese. Among the non-obese subjects, 22(73.3%) had at least one metabolic abnormality and were classified as non-obese Metabolic dysfunction-associated steatotic liver disease cases, while 8(26.7%) patients had no identifiable metabolic dysfunction and were labelled as simple steatosis cases. There was a significant difference in comorbidities between obese and non-obese metabolic dysfunction-associated steatotic liver disease (p<0.001). There was no significant difference noted in terms of physical activity between the groups (p>0.05).

Conclusion: About three-fourth of non-obese individuals with fatty liver met the diagnostic criteria for metabolic dysfunction-associated steatotic liver disease. Considering the benefits of early lifestyle interventions in such cases, clinicians should be aware of this diagnostic spectrum.

Key Words: MASLD, Non-obese MASLD, NAFLD, Hepatic steatosis, Metabolic dysfunction.