Risk of metabolic dysfunction-associated steatotic liver disease and hepatic fibrosis: a large-scale study from the Middle East.

There have been recent calls to increase the diagnosis rate of metabolic dysfunction-associated steatotic liver disease (MASLD). Here, we quantified the prevalence of MASLD-associated risk factors and identified individuals at risk of advanced fibrosis in a large, real-world cohort. This was a large, multicenter study of adults attending Dubai Academic Health Corporation between January 2018 and August 2023. MASLD risk factors were defined as the presence of one or more of the following: type 2 diabetes; obesity with ≥1 cardiometabolic risk factor; and/or raised ALT. Fibrosis-4 (FIB-4), a non-invasive index based on age, transaminases, and platelet count, was calculated, with moderate-high risk defined using established cut-offs (≥1.3 for <65 years; ≥2.0 for ≥65 years). Half (n = 46,412, 49.0%) of the population screened at risk of MASLD and, of those, 21.7% were at moderate-high risk of advanced fibrosis. 15.0% of individuals without MASLD risk factors, including those without obesity, were at moderate-high risk of fibrosis. Reliance solely on metabolic risk-based case finding may miss individuals at risk of advanced fibrosis, highlighting the value of broader fibrosis risk assessment strategies.