SAT-692 - Association of HbA1c and Obesity with Liver Fibrosis and Steatosis Measured by FibroScan in MASLD

Background:
Metabolic-associated steatotic liver disease (MASLD) affects ~38% of the global population and is strongly associated with insulin resistance, obesity, and type 2 diabetes. Progression to fibrosis and cirrhosis is driven by metabolic and inflammatory pathways, with hyperglycemia and adiposity as key contributors. Early detection of fibrosis is critical due to its association with mortality. While FIB-4 is widely used for screening, its accuracy may be limited in patients with obesity and diabetes. FibroScan offers a noninvasive assessment of liver steatosis and fibrosis.

Objective:
To evaluate the association of glycemic control (HbA1c) and obesity with liver fibrosis and steatosis, and to assess the correlation between FIB-4 and FibroScan measurements.

Methods:
We conducted a retrospective study of adult veterans (age 18–89) who underwent FibroScan at a single VA center (2018–2024). Inclusion required liver stiffness measurement (LSM), controlled attenuation parameter (CAP), and HbA1c within 6 months. Patients with significant alcohol use or other chronic liver diseases were excluded. HbA1c and BMI were categorized using standard clinical cutoffs. Outcomes included LSM (kPa) for fibrosis and CAP (dB/m) for steatosis. FIB-4 scores were calculated. Associations were assessed using Spearman's rank correlation and Kruskal–Wallis analyses.

Results:
Of 405 charts reviewed, 110 met inclusion criteria. The cohort was predominantly male (89%) and White (66%); 57% had diabetes and 61% had obesity. HbA1c correlated with fibrosis (ρ=0.49) and steatosis (ρ=0.32). BMI correlated with fibrosis (ρ=0.39) and more strongly with steatosis (ρ=0.52). FIB-4 showed weak correlation with fibrosis (ρ=0.25) and an inverse correlation with steatosis (ρ=−0.27). Fibrosis scores differed significantly between non-diabetes and diabetes groups (p=0.00008) and between non-diabetes and prediabetes (p=0.03), but not between prediabetes and diabetes (p=0.06). Steatosis differed between non-diabetes and diabetes (p=0.02), but not across other groups. FIB-4 did not differ between groups. A synergistic effect of elevated BMI and hyperglycemia was observed, with greater fibrosis and steatosis severity.

Conclusion:
Both poor glycemic control and obesity are associated with increased liver fibrosis and steatosis, with a synergistic effect when present together. FIB-4 demonstrated limited correlation with FibroScan measures, suggesting reduced utility in detecting liver disease severity in high-risk populations. These findings support the use of direct imaging modalities such as FibroScan for more accurate risk stratification in patients with diabetes and obesity.

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