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. 2025 Mar 28;8(2):322-328.
doi: 10.3138/canlivj-2025-0053. eCollection 2025 May.

Clinical and Biochemical Features of Diagnosed and Undiagnosed Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease

Gerald Yosel Minuk  1 , Mona Baseri  1 , Eleonora Bakalets  1 , Manna Zhang  1 , Julia Uhanova  1
Affiliations

Clinical and Biochemical Features of Diagnosed and Undiagnosed Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease

Gerald Yosel Minuk et al. Can Liver J. .

Abstract

Background: The majority of the world's metabolic dysfunction-associated steatotic liver disease (MASLD) patient population remain undiagnosed. Whether the clinical and biochemical features of these individuals resemble those with an established diagnosis of MASLD remains to be determined. The aim of this study was to document and compare the demographics, associated metabolic comorbidities, liver biochemistry, and non-invasive markers of hepatic fibrosis and portal hypertension in diagnosed versus undiagnosed MASLD patients.

Methods: The two study cohorts consisted of 3,101 MASLD patients attending a tertiary care centre (diagnosed) and 408 individuals with MASLD identified as a result of volunteering in a community-based MASLD screening clinic (undiagnosed).

Results: Diagnosed MASLD patients were younger (51±14 vs. 54±13 years, p <0.00001), more often male (50% vs. 34%, p <0.00001), and diabetic (40% vs. 17%, p <0.00001) but less often dyslipidemic (29% vs. 46%, p <0.00001). BMIs were similar in the two cohorts. The prevalence and extent of liver transaminases (ALT and AST) and function test (albumin, bilirubin, and INR values) abnormalities were greater in diagnosed MASLD patients as were non-invasive determinants of hepatic fibrosis and portal hypertension (higher FIB-4 values and lower platelet counts, respectively).

Conclusions: The demographics, metabolic co-morbidities, and severity of liver disease differ in diagnosed versus undiagnosed MASLD patients.

Keywords: MASH; MASLD; NAFLD; NASH; clinical features; fatty liver; hepatic fibrosis; hepatic inflammation.

Plain language summary

The majority of individuals with non-alcoholic fatty liver disease (NAFLD) remain undiagnosed. Whether these undiagnosed cases differ from those that have been diagnosed and referred to a tertiary care centre for care remains unclear. In this study we compared the clinical features of NAFLD in 408 individuals whose condition was identified during community screening with 3,101 individuals who had been previously diagnosed and referred to a tertiary care centre for further assessment and management. The results of the study revealed that yet undiagnosed NAFLD patients were younger, more often male, and diabetic but less often had lipid abnormalities compared with diagnosed/referred patients. The prevalence and extent of liver blood test abnormalities were greater in those who had been diagnosed/referred as were non-invasive assessments of hepatic fibrosis. Overall, these findings suggest that individuals with NAFLD in the community have different demographic features and less evidence of liver damage than NAFLD patients diagnosed and referred to a hospital setting for further investigation and management.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Figure 1:
Figure 1:. Prevalence of Liver Enzyme and Function Test Abnormalities in Diagnosed and Undiagnosed MASLD Patients
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