A RECENT study has provided new insights into the relationship between metabolic abnormalities and the progression of liver disease, focusing on individuals without diabetes. Chronic liver disease causes around 2 million deaths annually, with metabolic dysfunction-associated fatty liver disease (MAFLD) now recognised as the most prevalent form globally.
Affecting roughly 25% of adults, MAFLD spans a wide clinical spectrum, from simple steatosis to advanced fibrosis, cirrhosis, and liver cancer. Despite its growing burden, there remains no approved medical treatment beyond lifestyle modification, highlighting the importance of early identification of individuals at risk of progression.
This study assessed data from the 2017–2018 US NHANES dataset to explore the effects of various metabolic abnormalities, such as central obesity, high blood pressure, and elevated high-sensitivity C-reactive protein (hsCRP), on liver steatosis and fibrosis in non-diabetic populations. Researchers used liver elastography, a non-invasive method to measure liver stiffness and fat accumulation, finding that even in the absence of diabetes, metabolic dysfunction can significantly contribute to liver disease progression.
The study identified waist circumference, hypertension, and hsCRP as particularly strong predictors of fibrosis risk. These markers of central obesity, vascular stress, and systemic inflammation were shown to have a greater predictive value than BMI alone. Importantly, waist circumference outperformed BMI in identifying individuals at risk of both steatosis and fibrosis, suggesting that fat distribution may be more informative than overall body weight.
Findings also supported the relevance of the newer diagnostic frameworks for fatty liver disease, such as MAFLD and MASLD, which consider broader metabolic risk profiles rather than focusing solely on diabetes or obesity. Though these definitions differ slightly, both reflect the emerging emphasis on precision medicine and the need to capture risk in diverse patient populations.
The study highlights the importance of monitoring metabolic health, even in individuals without diabetes, as part of liver disease prevention strategies. Targeting modifiable risk factors such as blood pressure, central obesity, and inflammation may offer a practical approach to curbing the progression of MAFLD in at-risk groups.
Reference
Fu J et al. Association of metabolic abnormalities and the risk of hepatic fibrosis. NPJ Gut Liver. 2025;2:13. doi:10.1038/s44355-025-00025-z
