Basile Njei, MD, MPH, PhD: Increasing Lean MASLD Awareness, Improving Screening

New research is providing clinicians with an overview of the prevalence of lean metabolic dysfunction-associated steatotic liver disease (MASLD) in the United States, calling attention to the need for increased awareness and innovative screening methods to better capture patients who do not have overweight or obesity typically associated with MASLD.

The research was presented at the American College of Gastroenterology (ACG) 2024 Annual Scientific Meeting in Philadelphia, Pennsylvania, and showed an estimated 3.8 million lean US adults were living with MASLD as of 2020, about 87% of whom were likely unaware of their condition.

“Typically, people with MASLD are overweight and have diabetes or other cardiometabolic risk factors,” lead investigator Basile Njei, MD, MPH, PhD, an assistant professor at Yale School of Medicine, explained to HCPLive. “People who are lean, so people with a BMI of less than 25 overall or less than 23 in the Asian population, are often not diagnosed with MASLD because they don't typically have the risk factors that we expect.”

To estimate the national prevalence of lean MASLD among US adults, Njei and colleagues leveraged 2017-2020 National Health and Nutrition Examination Survey (NHANES) data for lean adults ≥18 years of age, defining MASLD as a controlled attenuation parameter ≥274 dB/m, clinically significant fibrosis as liver stiffness (LSM) ≥8 kPa, and clinically significant portal hypertension using AASLD/Baveno criteria based on LSM and platelet counts. Physician-diagnosed MASLD, fibrosis, and cirrhosis were identified using the Medical Conditions Questionnaire.

In total, the sample included 2086 unweighted (59 million weighted) lean individuals with an age-adjusted MASLD prevalence of 6.4% (95% CI, 4.3-9.4%). Among lean adults with diabetes, investigators noted this prevalence was higher (19.2%).

NHANES data projected 3.8 million lean US adults with MASLD, of whom 365,000 (9.6%) had LSM ≥ 8 kPa and 76 thousand had clinically significant portal hypertension. In the weighted analysis of the NHANES Medical Conditions Questionnaire, 473,000 lean US adults reported a diagnosis of MASLD (3.3 million undiagnosed) and 141,000 reported fibrosis/cirrhosis (224,000 undiagnosed).

“One of the ways that screening can be improved is to look at other markers of cardiometabolic risk that people who are lean do not usually have. A good example is insulin resistance, which is a simpler measure, and people can have insulin resistance even before they develop diabetes,” Njei explained, also describing his desire for further research exploring the incorporation of artificial intelligence and genetics into lean MASLD screening.

Reference

^{Njei B, Boateng S, Mohamed M, et al. P2977 - Sounding the Alarm on Lean MASLD in US Adults: Insights From NHANES 2017-2020. Paper presented at: ACG 2024 Annual Scientific Meeting. Philadelphia, Pennsylvania. October 25-30, 2024.}