Screening
Evaluation of noninvasive markers for metabolic dysfunction-associated steatotic liver disease among high-risk populations Christian S. Alvarez* Christian S. Alvarez Alvarez Alvarez Alvarez Alvarez Alvarez Alvarez Alvarez Alvarez Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Rockville, MD, USA
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major public health concern, with Hispanic populations experiencing a disproportionately high prevalence in the United States. Although transient elastography (TE) provides a reliable, noninvasive measure of hepatic steatosis, its use in population-based studies is limited by cost and logistics. As a result, steatotic liver indices are increasingly used; however, their agreement with TE has not been fully characterized in high-risk populations across different geographic settings.
Agreement between TE-derived controlled attenuation parameter (CAP) and steatotic liver indices was evaluated among Hispanic adults aged ≥40 years from the National Health and Nutrition Examination Survey (NHANES, 2017-2020) and the North American Liver Cancer Study (NALCS) conducted in Guatemala. MASLD was defined as CAP ≥263 dB/m. Indices included the fatty liver index (FLI), hepatic steatosis index (HSI), liver fat score (LFS), triglyceride-glucose waist-to-height ratio (TyG-WtHR), and lipid accumulation product (LAP). Concordance was assessed using weighted percent agreement. Accuracy in identifying CAP-defined MASLD was evaluated using area under the receiver operating characteristics curve (AUC). Analyses were stratified by sex.
The analytical sample included 592 participants from NHANES and 500 from NALCS. CAP-defined MASLD prevalence ranged from 57.9% (NHANES) to 59.2% (NALCS). Percent agreement between CAP and steatotic indices ranged from 60.2% to 74.1% with the highest agreement observed for LFS (74.1%) in NHANES and for FLI (71.4%) in NALCS. Overall accuracy for identifying CAP-defined MASLD was moderate, with AUC values ranging from 0.67 to 0.77 across indices and datasets. Results were broadly similar by sex.
Noninvasive steatotic liver indices demonstrated acceptable agreement with CAP-defined MASLD, supporting their use in population-based studies among high-risk groups across different geographic settings.