Almost one quarter of primary care patients with metabolic dysfunction have at-risk MASH, with type 2 diabetes and socioeconomic disadvantage among the biggest risk factors, an Australian study has revealed.

The researchers set out to establish the real-world burden of metabolic dysfunction-associated steatohepatitis (MASH) in general practice, particularly the prevalence of patients with more severe disease, which was largely unrecognised.

They drew on data from 110,938 patients with metabolic dysfunction, including MASLD, overweight/obesity, type 2 diabetes, dyslipidaemia and hypertension, who had been identified over a 12-month period from 84 GP practices in Victoria.

Of 16,586 patients with an available Fibrotic NASH Index (FNI) score, 24.3% had “at-­risk” MASH – defined as MASH and significant (F2+) fibrosis with FNI > 0.30.

Among the 64,948 patients with a Fibrosis-­ 4 (FIB-­4) index score available, 16.3% required further liver assessment for significant liver disease (FIB-­4 ≥ 1.3 and < 2.67, or ≥ 2.0 if 65+ years of age), while 4.3% had advanced fibrosis (> 2.67).

Male sex, type 2 diabetes and hypertension were all predictors of at-­risk MASH, while male sex and type 2 diabetes were associated with advanced liver fibrosis.

Notably, socioeconomic disadvantage was a risk factor for both at-­risk MASH and advanced liver fibrosis, underscoring the need for societal and health policy change to address health inequities and improve liver outcomes, said the University of Western Australia and University of Melbourne researchers.

“Highlighting the increased prevalence of at-­risk MASH and advanced liver fibrosis in patients who are socioeconomically disadvantaged is the first step in addressing the complex determinants of poor liver health,” they wrote in Alimentary Pharmacology & Therapeutics [link here]. “At a patient level, clinicians should be aware of the increased risk of more advanced liver disease and be attuned to the barriers to implementing health care in these populations.”

Odd ratios for at-risk MASH risk factors according to multivariate analysis:

• Male sex 2.06
• Type 2 diabetes 13.00
• Hypertension 1.41

Prevalence of at-risk MASH for most versus least disadvantaged:

• 25% vs 15.5%

Odd ratios for advanced liver fibrosis risk factors:

• Male sex 1.38
• Type 2 diabetes 1.24

Prevalence of advanced liver fibrosis for most versus least disadvantaged:

• 5.4%–6.1% vs 3.5%–4.4%

The researchers suggested patients with metabolic dysfunction should be screened for at-risk MASH, considering the high prevalence in their primary care cohort and the direct implications on patient management once identified.

“Recognition of these patients is valuable to support guideline-based screening and referral recommendations, identify those who are eligible for pharmacotherapy, as well as those who require further assessment or surveillance for future liver complications,” they said.

Novo Nordisk funded the study and two employees were study co-authors.