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

• Published in: BMC gastroenterology Vol. 24; no. 1; pp. 218 - 7
• Main Authors: Alkhouri, Naim, Almomani, Ashraf, Le, Phuc, Payne, Julia Y., Asaad, Imad, Polanco, Prido, Leff, Phillip, Kumar, Prabhat, Noureddin, Mazen
• Format: Journal Article
• Language: English
• Published: London BioMed Central 08.07.2024; BioMed Central Ltd; BMC
• Subjects: Adult; Advanced fibrosis; AGILE; Biopsy; Body mass index; Care and treatment; Cirrhosis; Diagnosis; Disease control; Distribution; Elastography; Fatty Liver - complications; Fatty Liver - epidemiology; Female; Fibrosis; Gastroenterology; Gender; Hemoglobin; Hepatitis B; Hepatology; Humans; Internal Medicine; Liver cirrhosis; Liver Cirrhosis - epidemiology; Liver diseases; Male; MASLD; Medicine; Medicine & Public Health; Metabolic diseases; Metabolism; Middle Aged; NHANES; Nutrition Surveys; Obesity; Population; Predictive Value of Tests; Prevalence; Severity of Illness Index; United States - epidemiology; United States; United States > US; Cirrhosis; AGILE; NHANES; Advanced fibrosis; MASLD; Elastography
• ISSN: 1471-230X; 1471-230X
• DOI: 10.1186/s12876-024-03295-8

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.