Liver Fibrosis in Asians With Metabolic Dysfunction–Associated Fatty Liver Disease

Background & aims: This study aimed to evaluate risk factors associated with liver fibrosis in metabolic dysfunction–associated fatty liver disease (MAFLD). Methods: A cross-sectional study of 967 Korean patients with MAFLD involved a cohort from a health screening program during the years 2015–2018. The patients were classified into 4 MAFLD subgroups: group 1 (overweight). group 2 (obese), group 3 (lean/normal weight with metabolic abnormalities), and group 4 (diabetes). Liver fibrosis was assessed based on liver stiffness measurement (LSM) value using 2-dimensional real-time magnetic resonance elastography. We investigated differences in liver fibrosis according to MAFLD subgroup classification and determined the risk factors for significant fibrosis. Results: The mean age was 50.8 years, and 869 (90%) patients were male. The mean value of LSM in magnetic resonance elastography was 2.48 ± 0.47 kPa. Significant fibrosis (LSM ≥2.97 kPa) was observed in 66 (6.8%) of 967 patients. The proportion of significant fibrosis in MAFLD group 1, group 2, group 3, and group 4 was 1.3%, 5.5%, 6.4%, and 18.9%, respectively (P <.001). Multivariable analysis indicated that the risk factors for significant fibrosis were serum ferritin ≥300 ng/mL (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.10–3.49; P =.023), Fibrosis-4 ≥1.3 (OR, 2.97; 95% CI, 1.68–5.24; P <.001), homeostatic model assessment of insulin resistance ≥2.0 (OR, 2.60; 95% CI, 1.25–5.43; P =.011), metabolic syndrome (OR, 2.53; 95% CI, 1.31–4.88; P =.006), and MAFLD group 4 (OR, 6.93; 95% CI, 1.96–24.51; P =.003). However, the etiology of liver disease was not statistically associated with liver fibrosis. Conclusion: Liver fibrosis in patients with MAFLD varies according to subgroup classification based on diabetes, body mass index, and metabolic risk factors.