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.