Rising Prevalence of Metabolic Dysfunction - Associated Steatotic Liver Disease in an urban South Indian screening cohort: a Retrospective Cross-sectional Study.

Purpose

Metabolic dysfunction-associated steatotic liver disease (MASLD), redefined in 2023 from non-alcoholic fatty liver disease, is highly prevalent globally, but population-level data using 2023 AASLD criteria and FibroScan-based assessment remain scarce in South Asia, particularly among asymptomatic adults undergoing routine health screening.

Methods

We conducted a retrospective cross-sectional study of 1,103 asymptomatic adults (mean age 43.1±12.7 years; 64.1% male) undergoing FibroScan-based Master Health Check-up at a tertiary centre in Chennai, India (2023-2025). MASLD was defined as controlled attenuation parameter (CAP) ≥249 dB/m plus ≥1 cardiometabolic risk factor; fibrosis was assessed by liver stiffness measurement (LSM).

Results

MASLD was identified in 716 participants (64.9%; 95% CI 62.1-67.7%). Affected individuals were older, had higher BMI, and more frequently had diabetes, hypertension, and dyslipidaemia (all p<0.01). In multivariable analysis, age, male sex, BMI, and diabetes were independently associated with MASLD. Notably, 53.4% of cases occurred in adults under 46 years, and 45.3% had normal liver function tests while 31.3% had normal ultrasound, indicating conventional screening substantially underestimates disease burden.

Conclusions

Nearly two-thirds of asymptomatic urban South Indian adults screened met MASLD criteria, predominantly working-age individuals under-detected by conventional tools. FibroScan-based screening should be considered in preventive health programmes to enable earlier detection.