Non-Invasive Assessment of MAFLD: The Role of Adiponectin and Metabolic Biomarkers in Liver Fibrosis Detection

Background: Metabolically associated fatty liver disease (MAFLD) is a growing concern in Egypt, replacing viral hepatitis as the dominant liver disease, linked to obesity, diabetes, and metabolic dysfunction. Aim: To assess the prevalence of MAFLD and investigate the role of serum adiponectin as a noninvasive liver fibrosis marker. Patients and Methods: A cross-sectional case-control study was conducted on 101 participants, divided into two groups: the MAFLD (90 patients) and non-MAFLD (11 participants). All participants were undergoing complete history taking and full clinical examination, laboratory investigations (CBC, liver/renal profile, lipid profile, fasting blood glucose, HbA1c, fasting insulin, and serum adiponectin), imaging studies (ultrasound and FibroScan), and fibrosis evaluation using non-invasive scores (APRI, FIB-4, NFS, HSI, and FLI). Results: MAFLD group patients had significantly higher BMI, waist circumference, FBS, HbA1c, and non-HDL-C. HDL and adiponectin (13.50 vs. 29.10 μg/L, p = 0.029) levels were considerably lower in MAFLD patients. Fibrosis and steatosis scores (LSM and CAP) were higher in the MAFLD group (p = 0.018, p < 0.001, respectively). MAFLD patients had more advanced liver involvement with higher liver stiffness stages (46.7%), higher CAP scores (53.3%), higher BARD scores (36.7%), and higher HSI (40.52 ± 9.34 vs. 34.02 ± 5.17). BMI was positively correlated with Hepatic Steatosis Index (HIS), METS-IR, triglycerides, VLDL-C, HbA1c, total cholesterol, LDL, non-HDL-C, TG/glucose ratio, BARD score, CAP, and LSM, while negatively correlated with LDL/VLDL ratio and adiponectin. The non-HDL cholesterol, total cholesterol, HbA1c, weight, BMI, and obesity are independent risk factors for the development of MAFLD, while adiponectin and HDL levels may serve as protective factors. The ROC curve analysis showed significant diagnostic value for diagnosing liver fibrosis in MAFLD patients. HbA1c had the highest diagnostic performance; HbA1c had an AUC of 0.839, HSI had an AUC of 0.767, BMI had an AUC of 0.762, and METS-IR had an AUC of 0.740, with high sensitivity and specificity. Adiponectin was found to be inversely associated with MAFLD. Conclusion: Serum adiponectin level is a useful noninvasive marker for the detection and risk assessment of MAFLD fibrosis. Combining biochemical and anthropometric data enhances early diagnosis, especially in settings that lack imaging facilities.