The Use of Non-invasive Biomarkers to Screen for Advanced Fibrosis Associated with Metabolic Dysfunction-associated Steatotic Liver Disease in People with Type 2 Diabetes: A Narrative Review

There is growing interest in metabolic dysfunction-associated steatotic liver disease (MASLD), given its increasing prevalence and our developing understanding of the disease. People living with type 2 diabetes or obesity have a greater risk of developing significant hepatic steatosis and a greater risk of more rapid progression to steatohepatitis, advanced hepatic fibrosis and hepatocellular carcinoma. As such, various international bodies now advocate for routine screening for MASLD-related hepatic fibrosis in people with such risk factors. This would permit earlier targeted lifestyle interventions and the use of pharmacotherapies, which may reverse earlier stages of MASLD-associated fibrosis. This may improve both liver-related and cardiovascular outcomes in these higher-risk groups. Nonetheless, the identification of MASLD-related hepatic fibrosis is frequently limited to liver enzyme tests, given the lack of a systematic approach to investigation and screening. In this article, we discuss the potential to screen for advanced fibrosis in people with MASLD using various blood-based biomarkers, such as the Fibrosis-4 score, non-alcoholic fatty liver disease fibrosis score and enhanced liver fibrosis test, amongst other available patented and non-patented tests. We discuss the relative benefits and limitations of each and the potential for future research in this evolving area of clinical interest.