Clinical and Metabolic Determinants of Hepatic Fibrosis in Patients with Metabolically – Associated Steatotic Liver Disease (MASLD) – Insights from a Bangladeshi Cohort

Open Access

Abstract

Introduction: Metabolic dysfunction–associated steatotic liver disease (MASLD) is now the most common chronic liver disease globally, driven largely by obesity, insulin resistance, and diabetes. Hepatic fibrosis is the strongest predictor of long-term outcomes, yet data on its clinical and metabolic determinants in Bangladeshi patients are scarce. Identifying simple, accessible predictors of significant fibrosis is essential for early risk stratification in resource-limited settings. Methods & Materials: This cross-sectional study was conducted in the Department of Hepatology, BSMMU, from January 2014 to December 2015, including 40 adults with biopsy-proven MASLD. Clinical parameters, metabolic variables (diabetes, impaired glucose tolerance, HOMA-IR), biochemical markers (AST/ALT ratio), and histological features (NAS components, fibrosis stage) were assessed. Patients were categorized into mild/no fibrosis (F0–F1) and significant fibrosis (F2–F4). Results: Of 40 patients, 18 (45%) had significant fibrosis. Those with fibrosis had higher BMI (28.2 ± 3.2 vs. 25.7 ± 3.8 kg/m², p=0.032), with BMI ≥28 kg/m² markedly more common (72.2% vs. 18.2%, p=0.001). Diabetes (50.0% vs. 9.1%, p=0.005) and IGT (27.8% vs. 0%, p=0.013) were significantly associated with fibrosis, as was higher HOMA-IR (2.7 ± 0.7 vs. 1.9 ± 0.4, p=0.001). AST/ALT ratio ≥0.8 strongly predicted fibrosis (61.1% vs. 13.6%, p=0.001). Histologically, lobular inflammation ≥2 (p=0.013) and NASH (72.2% vs. 31.8%, p=0.011) were more frequent in the fibrosis group. Multivariate analysis identified BMI ≥28 kg/m², diabetes, AST/ALT ratio ≥0.8, and NASH as independent predictors. Conclusion: Obesity, diabetes, elevated AST/ALT ratio, and histologic NASH are key determinants of significant fibrosis in Bangladeshi patients with MASLD.