Evaluation of the prevalence of MASLD, MASH and liver fibrosis in a Dutch bariatric cohort.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Liver Cirrhosis*/epidemiology ; Liver Cirrhosis*/diagnosis ; Liver Cirrhosis*/pathology ; Fatty Liver*/epidemiology ; Fatty Liver*/diagnosis ; Fatty Liver*/pathology ; Non-alcoholic Fatty Liver Disease*/epidemiology ; Bariatric Surgery*; Netherlands/epidemiology ; Liver/pathology ; Humans ; Female ; Male ; Prevalence ; Middle Aged ; Adult ; Cross-Sectional Studies ; Elasticity Imaging Techniques ; Cohort Studies ; ROC Curve

Background and Aims: The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) in bariatric populations has been widely studied but may vary geographically. This study evaluates MASLD/MASH prevalence and the utility of non-invasive tests (NITs) for liver fibrosis in a Dutch bariatric surgery cohort.
Methods: This single-center cross-sectional diagnostic accuracy study included 220 patients undergoing bariatric surgery. At baseline, 10 NITs were performed. Patients with liver stiffness measurements ≥ 8kPa using vibration-controlled transient elastography underwent a liver biopsy during surgery. Histology was assessed using the nonalcoholic fatty liver disease Activity Score. Diagnostic accuracy of NITs was evaluated against histology using sensitivity, specificity, and area under the receiver operating characteristic (AUROC). MASH was defined as steatosis with lobular inflammation and ballooning, with or without fibrosis. At-risk MASH included fibrosis ≥F2.
Results: Out of 77 patients (35%) eligible for histological analysis, the findings revealed a MASLD prevalence of 50.6%, MASH prevalence of 5.3%, and at-risk MASH prevalence of 2.6%. Most patients had no fibrosis (67.1%), while others exhibited mild fibrosis (F1: 23.7%, F2: 9.2%). Capped MAF-5 effectively identified fibrosis stage ≥2 (AUROC: 0.809), surpassing FIB-4 (AUROC: 0.645). Both the FAST score and capped MAF-5 demonstrated strong performance in detecting at-risk MASH.
Conclusion: MASLD/MASH prevalence and advanced fibrosis were lower than expected in this Dutch cohort. Capped MAF-5 demonstrated superior performance for fibrosis detection, while transient elastography and FIB-4 were less reliable. Further studies are needed to optimize NIT selection in bariatric populations.
(Copyright: © 2025 Theel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The authors have declared that no competing interests exist.

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Date Created: 20250624 Date Completed: 20250624 Latest Revision: 20250626

20260130

PMC12186956

10.1371/journal.pone.0324813

40554612