FREQUENCY OF METABOLIC-DYSFUNCTION ASSOCIATED STEATOTIC LIVER DISEASE IN DIABETIC INDIVIDUALS USING NON-INVASIVE SCORE.

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in people with type 2 diabetes mellitus and may progress to clinically important liver disease. The Fatty Liver Index (FLI) is a simple non-invasive score derived from routinely available anthropometric and biochemical variables and may help identify hepatic steatosis when imaging is not immediately available. Objective: To determine the frequency of steatotic liver disease in patients with type 2 diabetes mellitus using the FLI, evaluate its diagnostic performance against abdominal ultrasonography, and identify demographic, anthropometric, and biochemical factors associated with ultrasound-confirmed steatosis. Methods: This hospital-based cross-sectional observational study included 124 consecutive patients with type 2 diabetes mellitus attending the diabetic clinics and Medical Outpatient Department of Jinnah Postgraduate Medical Centre, Karachi, from mid-March 2026 to mid-June 2026. Demographic, clinical, anthropometric, and biochemical data were collected using a structured proforma. The FLI was calculated from body mass index, waist circumference, triglycerides, and gamma-glutamyl transferase. Abdominal ultrasonography was used as the reference standard for hepatic steatosis. Diagnostic performance was evaluated using sensitivity, specificity, predictive values, diagnostic accuracy, Cohen’s kappa, and receiver operating characteristic analysis. Multivariable binary logistic regression was used to identify independent predictors of ultrasound-confirmed steatosis. Results: The mean age was 50.00 ± 10.31 years, and 71.0% of participants were female. Ultrasound-confirmed hepatic steatosis was present in 88 participants (71.0%), whereas 77 (62.1%) had FLI ≥60. At this threshold, sensitivity was 73.9%, specificity 66.7%, positive predictive value 84.4%, negative predictive value 51.1%, and overall diagnostic accuracy 71.8%. Agreement with ultrasonography was fair (Cohen’s kappa = 0.372, p < 0.001), and the area under the receiver operating characteristic curve was 0.776. Participants with steatosis had significantly higher body mass index, waist circumference, alanine aminotransferase, and gamma-glutamyl transferase levels. In multivariable analysis, body mass index was the only independent predictor of steatosis (adjusted OR 1.270, 95% CI 1.121–1.438; p < 0.001). Conclusion: Hepatic steatosis was common in this hospital-based sample of patients with type 2 diabetes mellitus. The FLI showed acceptable discrimination and a high positive predictive value, but its modest sensitivity and low negative predictive value indicate that an FLI <60 should not be used alone to exclude steatosis. Body mass index was independently associated with ultrasound-confirmed steatosis. Keywords: body mass index; diabetes mellitus, type 2; Fatty Liver Index; metabolic dysfunction-associated steatotic liver disease; ultrasonography