The Prevalence and Risk Factors for at‐Risk MASH and Advanced Liver Fibrosis in People With Metabolic Risk Factors in Primary Care

BACKGROUND: The majority of the burden of metabolic dysfunction-associated steatohepatitis (MASH) exists in primary care; however, the prevalence of severe disease in patients with metabolic dysfunction remains poorly described. METHODS: A cross-sectional study of 84 general practices located in Victoria, Australia identified patients with metabolic dysfunction over a 12 month period from the PATRON data repository. At-risk MASH was defined using the Fibrotic NASH Index (FNI) based on laboratory data. Patients needing further liver assessment were defined by FIB-4 ≥ 1.3 (≥ 2.0 if 65+ years) and = < 2.67. Advanced liver fibrosis was defined as a FIB-4 of > 2.67. RESULTS: 110,938 individuals were identified with metabolic dysfunction. Of those with a FNI available (n = 16,586), the prevalence of At-risk MASH was 24.3%. Among those with a FIB-4 available (n = 64,948), 16.3% required further liver assessment, while the prevalence of advanced fibrosis was 4.3%. On multivariate analysis, male sex, type 2 diabetes, and hypertension were associated with At-risk MASH, whereas male sex and type 2 diabetes were associated with advanced liver fibrosis. Socio-economic disadvantage was a risk factor for both At-risk MASH and advanced liver fibrosis. CONCLUSIONS: Significant liver disease was observed in a substantial proportion of patients with metabolic dysfunction within primary care, particularly among patients with type 2 diabetes, supporting the rationale for risk stratification. Associations with socio-economic disadvantage highlight the need for societal and public health policy change to improve liver outcomes.