The paradox of high metabolic risk and low FIB-4 scores in the elderly: a nationwide community-based analysis (DAHUDER geriatric MASLD study)
Year: 2026
Type: article
Study design: Observational Study
Abstract: This study aimed to determine the prevalence of metabolic dysfunction–associated steatotic liver disease (MASLD) in community-dwelling Turkish adults aged ≥ 65 years with at least one cardiometabolic risk factor (CMRF) and to identify risk factors associated with liver fibrosis. This nationwide study is a retrospective cross-sectional analysis of prospectively collected data from 31 cities and 44 internal medicine outpatient clinics representing all statistical regions of Türkiye. A total of 2613 older individuals (mean age 71.55 ± 5.40, 62.8% female) were enrolled in the study. The prevalence of MASLD ( N = 1811) and high FIB-4 ( N = 412) was 69.3% and 15.8% in the all patient group, respectively. The mean FIB-4 score was significantly lower in MASLD group ( P < 0.001). The prevalence of smoking (8.7%, P = 0.034), type 2 diabetes mellitus (T2DM) (54.4%, P < 0.001), metabolic syndrome (83.7%, P < 0.001), obesity (42.2%, P = 0.004), dyslipidemia (45.6%, P = 0.001) and MASLD (59.2%, P < 0.001) was found to be lower in the high FIB-4 group. Moreover, the prevalence of high FIB-4 progressively decreased with the number of CMRFs, ranging from 35.9% in participants with one factor to 13.3% in those with all five factors. In the multivariable regression analysis; female sex [OR: 0.763, (95%CI: 0.605–0.961); ( P = 0.022), smoking [0.610, (95%CI: 0.419–0.889); ( P = 0.010)], T2DM [OR: 0.722, (95%CI: 0.575–0.905); P = 0.005], MASLD [OR: 0.671, (95%CI: 0.533–0.844); ( P = 0.001)] were independently and negatively associated with high FIB-4 score. Despite high MASLD prevalence in older Turkish adults, the FIB-4 score negatively correlates with CMRFs, rendering it unreliable. These findings suggest that FIB-4 may be driven by age and age-related changes rather than liver pathology in this population, significantly limiting its utility as a screening tool in geriatric care.
Source: Diabetology & Metabolic Syndrome
Authors: Ali Kirik, Hilmi Erdem Sümbül, Nizameddin Koca, Selçuk Yaylacı, Sibel Ocak Serin, Seyit Uyar, Alihan Oral, Ahmet Aydın, Süleyman Emre Koçyiğit, İsmail Demir, Nevzat Gözel, Pınar Yıldız, Oğuzhan Sıtkı Dizdar, Enes Seyda Şahiner, Kubilay İşsever, Emin Gemcioğlu, Hasan Esat Yücel, Cem Şahin, Hasan Sözel, Osman Özüdoğru, Gokhan Tazegul, Melisa Şahin Tekin, Emel Sağlam, Huseyin Ali Ozturk, Demet Yalçın Kehribar, Hasan Tunca, Elif Duygu Topan, Tuba Taslamacıoğlu Duman, Abdullah Tanrıkulu, Hakan Şıvgın, Hikmet Öztop, Muhammet Özbilen, Necip Nas, Mehmet Selim Mamiş, Özge Kurtkulağı, Kamil Konur, İsmail Kırlı, Fatih Kamış, Özge Kama Başcı, Ahmed Bilal Genç, Müzeyyen Eryılmaz, Betül Erişmiş, Yasin Şahintürk, Nur Düzen Oflas, Erkan Dulkadiroğlu, Ayse Kevser Demir, Deniz Cekiç, Erkan Çakmak, Hatice Beyazal Polat, Hilal Bektaş Uysal, Türkan Paşalı Kilit, Sibel Demiral Sezer, Emine Binnetoglu, Eşref Araç, İhsan Solmaz, Hacer Şen, Gulali Aktas, Burçin Meryem Atak Tel, Lale Saka Baraz, Bahri Abaylı, Hale Akan, Canan Akkuş, Berrin Aksakal, Sami Bahçebaşı, Orhan Balıkçı, Muharrem Bayrak, Ömer Faruk Alakuş, İfakat İrem Biçer, Rıfat Bozkuş, Bilgin Bahadır Başgöz, Fatih Coşkun, Cüneyt Çağatay, Feride Çağlar, Ülfet Değer, Ali Erol, Ayşegül Ertınmaz, Melis Gökgöz, Fatih İleri, Uğur Can İzlimek, Aynur Kamburoğlu, Sanem Kayhan, Yusuf Kimyon, Şeref Enes Kocaman, Celalettin Küçük, Hatice Metin, Oktay Olmuşçelik, Erkan Özdemir, Ensar Özmen, Hatice Özge Serin, Ahmet Veli Şanibaş, Ece Ünal Çetin, Nazif Yalçın, Mehmet Serdar Yıldırım, Hasan Esat Yıldırım, Hüseyin Yıldız, Oğuzhan Zengin, Ali Zeynettin, Fatih Atik, Selin Müge Aslan, Mert Akyıldız, Nurcan Aslan, Sare Babacan Çelikel, Suat Baran Bakan, Merve Durmuş, Mert Karacay, Çağatay Koçyiğitoğlu, Gökçe Paşa, Selvinaz Sivri, Tutku Naz Şahin, Yağmur Sena Tosun, Zeynep Gizem Totik, Rabia Ulutaş, Tuğçe Nur Yazıcı, Emrah Yılmaz, Muhammed Raşit Altınışık, Hamit Yıldız, Yusuf Yilmaz
Institutions: Balıkesir University, Sağlık Bilimleri Üniversitesi, Bursa City Hospital, Sakarya University, Ümraniye Eğitim ve Araştırma Hastanesi, Antalya Eğitim ve Araştırma Hastanesi, Biruni University, Istanbul Medipol University, İzmir Şehir Hastanesi, Fırat University, Eskişehir Osmangazi University, Kayseri Eğitim ve Araştırma Hastanesi, Ankara Bilkent City Hospital, Giresun University, Ankara Etlik City Hospital, Ankara Eğitim ve Araştırma Hastanesi, Ahi Evran University, Muğla University, Akdeniz University, Akdeniz University Hospital, Marmara Üniversitesi Eğitim ve Araştırma Hastanesi, Marmara University, Bağcılar Eğitim ve Araştırma Hastanesi, Dokuz Eylül University, Adnan Menderes University, Bolu Abant İzzet Baysal University, Siirt Üniversitesi, Tokat Gaziosmanpaşa Üniversitesi, Bursa Uludağ Üni̇versi̇tesi̇, Ordu University, Çanakkale Onsekiz Mart Üniversitesi, Recep Tayyip Erdoğan University, Fatih Sultan Mehmet Eğitim Ve Araştırma Hastanesi, Van Yüzüncü Yıl Üniversitesi, Samsun University, Kutahya Saglik Bilimleri Universitesi, Dicle University, Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi, Seyhan Devlet Hastanesi, S.B.Ü. Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Malatya Devlet Hastanesi, Gaziantep University
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,890
OpenAlex ID: W7225398753