The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD)-related advanced fibrosis and cirrhosis in the United States population utilizing AGILE 3 + and AGILE 4 scores: analysis of the NHANES 2017–2018 cycle

Naim Alkhouri, Ashraf Almomani, Phuc Le, Julia Y. Payne, Imad Asaad, Prido Polanco, Phillip Leff, Prabhat Kumar, Mazen Noureddin

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1 Scopus citations

Abstract

Background: Studies attempted to estimate MASLD-related advanced fibrosis (AF) and cirrhosis (MC) prevalence utilized tests with low positive predictive value (PPV) which overestimates prevalence. AGILE3 + and 4 scores were developed to increase the PPV of both; respectively. In this study, we used these scores to assess the prevalence of AF and MC. Methods: Participants aged ≥ 18 years with VCTE exam in the NHANES 2017–2018 cycle were included. We excluded pregnant women, patients with excessive alcohol intake, hepatitis B/C, and ALT or AST > 500 IU/L. MASLD was defined with CAP score > 248 dB/m. MASLD subjects with AGILE 3 + score of ≥ 0.68 and AGILE 4 score of ≥ 0.57 were considered to have advanced fibrosis and cirrhosis; respectively. AGILE 3 + of 0.45–0.67 and AGILE 4 of 0.25–0.57 were grey zone, whereas AGILE 3 + < 0.45 and AGILE 4 < 0.25 were considered a rule-out. Results: 1244 subjects were included in the final analysis. The Median age was 53 (51.4–54.6) years, 55.6% were male, median BMI was 33.8 kg/m2 and 41.1% had T2DM. Based on AGILE 3+, 80.3% of the MASLD population were at low risk for AF and 11.5% were in grey zone. The prevalence of AF due to MASLD was 8.1% corresponding to 4.5 million Americans. Based on AGILE 4 score, 96.5% of the MASLD population were at low risk for cirrhosis and 2.4% were in the grey zone. The prevalence of MASLD-cirrhosis was 1.1% corresponding to 610,000 Americans. Conclusion: Our results suggest that approximately 4.5 million people in the U.S. have AF and 0.6 million have cirrhosis due to MASLD.

Original languageEnglish (US)
Article number218
JournalBMC Gastroenterology
Volume24
Issue number1
DOIs
StatePublished - Jul 8 2024

Keywords

  • AGILE
  • Advanced fibrosis
  • Cirrhosis
  • Elastography
  • MASLD
  • NHANES
  • Severity of Illness Index
  • Predictive Value of Tests
  • Prevalence
  • Nutrition Surveys
  • Humans
  • Middle Aged
  • Male
  • Fatty Liver/epidemiology
  • United States/epidemiology
  • Liver Cirrhosis/epidemiology
  • Female
  • Adult

ASJC Scopus subject areas

  • Gastroenterology

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