Study of the Prevalence and Factors Associated with Metabolic Dysfunction-Associated Steatotic Liver Disease among Patients with Type 2 Diabetes Mellitus Attending the Outpatient Department of Ratchaburi Hospital

Abstract

        Background: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a common chronic liver disease among patients with type 2 diabetes mellitus (T2DM) and is associated with an increased risk of advanced liver fibrosis, cirrhosis, and cardiovascular disease. Current clinical practice guidelines recommend using the Fibrosis-4 Index (FIB-4) as an initial non-invasive tool for liver fibrosis risk stratification. However, evidence regarding the prevalence of MASLD and the association between FIB-4 risk categories and MASLD among patients with T2DM in provincial hospitals in Thailand remains limited.

        Objective: To determine the prevalence of MASLD, identify demographic and metabolic factors associated with MASLD, examine the association between FIB-4 risk categories and MASLD, and evaluate the ability of the FIB-4 Index to discriminate between patients with and without MASLD among patients with T2DM attending the outpatient department of Ratchaburi Hospital.

        Methods: A retrospective cross-sectional analytic study was conducted using electronic medical records of 1,985 adults with T2DM attending the outpatient department of Ratchaburi Hospital during the 2024 fiscal year. MASLD was diagnosed based on ultrasonography, computed tomography (CT), transient elastography (FibroScan), or clinical diagnosis by a gastroenterologist. Data were analyzed using descriptive statistics, group comparison tests, multiple logistic regression, and receiver operating characteristic (ROC) curve analysis. Statistical significance was defined as p < 0.05.

        Results: The prevalence of MASLD was 14.2%. Based on the FIB-4 Index, 75.6%, 19.1%, and 5.3% of participants were classified as low-, intermediate-, and high-risk, respectively. Patients with MASLD had significantly higher age, body mass index, duration of diabetes, HbA1c, LDL-C, triglyceride, AST, and ALT levels, and lower HDL-C levels than those without MASLD (p < 0.05). Multivariable logistic regression showed that triglyceride levels ≥150 mg/dL (adjusted OR = 2.08; 95% CI: 1.57–2.75) and intermediate/high FIB-4 risk (adjusted OR = 1.96; 95% CI: 1.42–2.72) were independently associated with MASLD. At a cutoff value of 1.30, the FIB-4 Index demonstrated 74.5% sensitivity, 77.3% specificity, 76.9% accuracy, and an area under the ROC curve (AUC) of 0.812 (95% CI: 0.784–0.840), indicating good discriminative performance for distinguishing patients with and without MASLD.

        Conclusion: The prevalence of MASLD among patients with T2DM was 14.2%. Elevated triglyceride levels and intermediate/high FIB-4 risk were independently associated with MASLD. Although the FIB-4 Index is not intended for the diagnosis or screening of MASLD, it demonstrated good discriminative performance and may serve as a practical non-invasive tool for liver fibrosis risk stratification, facilitating the identification of patients who may benefit from further evaluation, such as transient elastography (FibroScan), or referral to a specialist in accordance with current clinical practice guidelines.