Screening for metabolic-associated fatty liver disease in type 2 diabetes patients using non-invasive scores and ultrasound: a cross-sectional study in Egypt

Abstract

BACKGROUND: MAFLD is very common among T2DM patients and contributes significantly to both liver and systemic complications. This study aimed to evaluate the reliability of non-invasive scores and abdominal ultrasound for diagnosing and screening MAFLD in Egyptian T2DM patients. METHODS: A cross-sectional study was conducted on 300 patients with T2DM who attended the Diabetes Outpatient Clinic at Benha Teaching Hospital. Liver enzymes, non-invasive fibrosis (FIB-4 and NFS), and steatosis (HSI and FLI) indices were evaluated alongside abdominal ultrasonography. Patients were stratified into two groups based on MAFLD diagnosis and assessed for disease presence and severity predictors using logistic regression models. RESULTS: MAFLD prevalence was 46.33%. FIB-4 with an AUC of 0.826 (95% CI:0.778-0.875)and NFS with an AUC of 0.964 (95% CI:0.942-0.986) demonstrated high diagnostic accuracy for fibrosis, while HSI with an AUC of 0.847 (95% CI:0.803-0.890) and FLI with an AUC of 0.835 (95% CI:0.789-0.881) effectively identified hepatic steatosis. The HSI (38.31 ± 6.93) and FLI (68.78 ± 29.98) placed patients in the high probability category for liver steatosis, while the FIB-4 (1.94 ± 0.81) and NFS (0.56 ± 1.24) scores indicated moderate fibrosis risk. Ultrasound findings corroborated these results, with 80.58% of patients presenting with mild to moderate steatosis. Higher BMI, increased waist circumference, elevated liver function markers (elevated ALT, AST, GGT, and albumin), higher lipid profile, and poor glycemic control (HbA1c) were key predictors of MAFLD. CONCLUSIONS: Non-invasive indices alongside ultrasound support screening efforts to detect MAFLD in T2DM patients early, offering opportunities for timely management and prevention of disease progression.