Endocrine Abstracts

JOINT48

Background and Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading chronic liver condition globally, affecting individuals across various ages and ethnicities. It strongly correlates with obesity (over 70% of metabolic-associated steatohepatitis [MASH] cases occur in obese individuals), type 2 diabetes mellitus (T2DM; nearly 75% of MASH patients have T2DM), hyperlipidemia (20–80% show elevated cholesterol and triglycerides), and atherosclerosis. Since metabolic dysfunction is a cornerstone of MASLD, its diagnosis necessitates confirmation of hepatic steatosis alongside at least one of five cardiometabolic risk factors. Early detection of MASLD, especially in individuals with excess weight or obesity, through liver enzyme evaluation (alanine aminotransferase [ALT], gamma-glutamyl transpeptidase [GGT], and aspartate aminotransferase [AST]), and fibrosis assessment—coupled with prompt treatment and risk factor management—can curb disease progression and associated complications, while reducing socio-economic burdens.

Methods: The study involved 36 women, aged 24–64 years, with body mass indices (BMI) ranging from 30.5 to 69.8 kg/m², all scheduled for bariatric surgery. They underwent screening for MASH through clinical assessments, including blood tests to measure ALT, AST, and GGT levels, as well as hemoglobin A1c (HbA1c). Selection criteria prioritized elevated ALT levels, ALT/AST ratios below 1, and raised GGT levels. HbA1c levels above 6.5% confirmed diabetes mellitus. Liver enzyme levels were determined via colorimetric biochemical methods, while HbA1c was measured using high-performance liquid chromatography. Blood pressure (BP) was recorded in the seated position using a mercury sphygmomanometer. Hepatic steatosis was graded using ultrasound steatometry.

Results: MASLD was diagnosed in all participants. MASH was identified in 39%, with steatosis categorized as S1 in 21%, S2 in 50%, and S3 in 77.8% of cases. Elevated ALT, AST, and GGT levels were noted in 11% of patients with BP exceeding 140/90 mm Hg. HbA1c levels >6.5% alongside increased liver enzymes were seen in 6% of cases. Simultaneous elevations in ALT, AST, GGT, HbA1c, and BP >140/90 mm Hg occurred in 6% of patients.

Conclusions: MASLD was detected in all obese participants, regardless of T2DM or hypertension status. MASH was most prevalent among women with advanced steatosis (S3; 77.8%). Women with obesity and hypertension had a higher occurrence of MASH (11%) compared to those with obesity and T2DM (6%) or both conditions combined (6%).