Prevalence of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) and Advanced Fibrosis in Type 2 Diabetes Mellitus Patients

Abstract

Background: Type 2 Diabetes Mellitus (T2DM) plays a key role in the development of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) and advanced fibrosis, which is the strongest predictor of liver-related mortality. Identifying “silent” advanced disease in Pakistan, where T2DM prevalence is exceptionally high, through cost-effective non-invasive tests (NITs) is essential for early identification of risk factors and specialist referral accordingly.

Objective: To estimate the prevalence of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) and advanced liver fibrosis in patients with Type 2 Diabetes Mellitus (T2DM) using non-invasive tests (NITs) in a tertiary care setting in Pakistan, and to identify clinical predictors of advanced disease. Methods: This cross-sectional study analyzed 180 adult patients with T2DM presenting to the Diabetes Management Center, Services Institute of Medical Sciences (SIMS), Lahore. Clinical and biochemical data were extracted from the study dataset. The Hepatic Steatosis Index (HSI) was calculated to identify likely steatosis (cutoff ≥ 36), and the Fibrosis-4 (FIB-4) index was used to stratify the risk of advanced fibrosis (cutoff ≥ 2.67). Data analysis involved descriptive statistics and independent t-tests, with complete-case analysis applied to handle missing data for the primary outcome. Results: Valid FIB-4 scores were calculable for 180 patients (82.6%) . Mean age of the cohort was 48.6 ± 11.2 years, and the mean Body Mass Index (BMI) was 28.4 ± 5.8 kg/m². The prevalence of MAFLD (HSI ≥ 36) was found to be 68.3% (123/180). The prevalence of likely advanced fibrosis (FIB-4 ≥ 2.67) was 5.6% (10/180), while 22.2% (40/180) were categorized as indeterminate risk (FIB-4 1.30–2.67). Patients with advanced fibrosis were significantly older (60.1 vs. 48.2 years, p<0.01) with a longer duration of diabetes (15.2 vs. 8.4 years, p<0.01) as compared to the non-advanced fibrosis group. Platelet counts were very low in the high-risk group (168 vs. 282 × 10⁹/L, p<0.001). Conclusions: MAFLD is highly endemic among Pakistani T2DM patients, and affect more than two-thirds of the study population. Although the point prevalence of advanced fibrosis (5.6%) appears small but still significant as it identifies a critical high-risk subgroup that should bereferred to a hepatologist immediately.  Age and duration of diabetes are strong predictors of fibrosis risk. Routine screening with FIB-4 should be included into diabetes care protocols in Pakistan.

Keywords:  MAFLD, MASLD, Type 2 Diabetes, Fibrosis-4 (FIB-4), Hepatic Steatosis Index, Pakistan.