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Background <p>Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) encompasses diverse hepatic and metabolic dysfunctions.</p> Aim <p>To assess the relationship between cumulative metabolic burden and the severity of hepatic fibrosis and steatosis in MAFLD patients.</p> Methods <p>A cross-sectional study of 357 MAFLD patients classified by metabolic burden (one, two, or three risk factors: obesity, diabetes, and metabolic dysregulation). Fibrosis and steatosis were assessed noninvasively using the Fibrosis-4 (FIB-4) score and Fatty Liver Index (FLI).</p> Results <p>Advanced fibrosis (FIB-4 ≥ 2.67) was infrequent (5.3%) and showed no significant variation across metabolic burden subgroups (<i>p</i> = 0.907). Instead, multivariate analysis identified age (OR = 1.16, <i>p</i> = 0.008), diabetes (OR = 4.40, <i>p</i> = 0.033), AST (OR = 1.13, <i>p</i> &lt; 0.001), and low platelets (OR = 0.96, <i>p</i> = 0.018) as independent fibrosis predictors. In contrast, advanced steatosis (FLI &gt; 96) increased significantly with metabolic burden (16.4%, 21.9%, and 39.5% across subtypes 1–3; <i>p</i> &lt; 0.001). Steatosis was independently associated with subtype 3 (OR = 7.20, <i>p</i> = 0.036), BMI (OR = 1.64, <i>p</i> &lt; 0.001), GGT (OR = 1.03, <i>p</i> &lt; 0.001), age (OR = 1.06, <i>p</i> = 0.011), and waist/hip ratio (OR = 2.63, <i>p</i> &lt; 0.001).</p> Conclusion <p>In MAFLD, metabolic burden strongly predicts steatosis but not fibrosis. Fibrosis is determined by age, diabetes, and biochemical markers, whereas steatosis reflects cumulative metabolic clustering, particularly obesity. These findings underscore distinct pathogenic pathways and support tailored approaches to risk stratification.</p>

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Association of metabolic risk factors with the severity of hepatic fibrosis and steatosis in metabolic dysfunction-associated fatty liver disease patients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月16日

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  • Maha Elsabaawy,
  • Warda Othman,
  • Sameh Afify,
  • Tamer Samir,
  • Madiha Naguib

摘要

Background

Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) encompasses diverse hepatic and metabolic dysfunctions.

Aim

To assess the relationship between cumulative metabolic burden and the severity of hepatic fibrosis and steatosis in MAFLD patients.

Methods

A cross-sectional study of 357 MAFLD patients classified by metabolic burden (one, two, or three risk factors: obesity, diabetes, and metabolic dysregulation). Fibrosis and steatosis were assessed noninvasively using the Fibrosis-4 (FIB-4) score and Fatty Liver Index (FLI).

Results

Advanced fibrosis (FIB-4 ≥ 2.67) was infrequent (5.3%) and showed no significant variation across metabolic burden subgroups (p = 0.907). Instead, multivariate analysis identified age (OR = 1.16, p = 0.008), diabetes (OR = 4.40, p = 0.033), AST (OR = 1.13, p < 0.001), and low platelets (OR = 0.96, p = 0.018) as independent fibrosis predictors. In contrast, advanced steatosis (FLI > 96) increased significantly with metabolic burden (16.4%, 21.9%, and 39.5% across subtypes 1–3; p < 0.001). Steatosis was independently associated with subtype 3 (OR = 7.20, p = 0.036), BMI (OR = 1.64, p < 0.001), GGT (OR = 1.03, p < 0.001), age (OR = 1.06, p = 0.011), and waist/hip ratio (OR = 2.63, p < 0.001).

Conclusion

In MAFLD, metabolic burden strongly predicts steatosis but not fibrosis. Fibrosis is determined by age, diabetes, and biochemical markers, whereas steatosis reflects cumulative metabolic clustering, particularly obesity. These findings underscore distinct pathogenic pathways and support tailored approaches to risk stratification.