ORIGINAL ARTICLE OPEN ACCESS Journal of the College of Physicians and Surgeons Pakistan 2023, Vol. 33(04): 390-395 390 Non-invasive Screening of Metabolic Associated Fatty Liver Disease and Affecting Factors in Primary Care Idil Ceren Balci, Nazli Haciagaoglu, Can Oner, Huseyin Cetin and Engin Ersin Simsek Department of Family Medicine, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Kartal, Istanbul, Turkiye ABSTRACT Objective: To identify the presence of MAFLD (metabolic associated fatty liver disease) with some non-invasive screening methods and the factors affecting in patients with metabolic dysfunction. Study Design: A cross-sectional study. Place and Duration of the Study: University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkiye, from March to June 2021. Methodology: This study included 233 participants with metabolic disease over the age of 18 who applied to family medicine clinics. The participants' sociodemographic data, chronic disease status, biochemical parameters, waist circumference, weight, height, body mass index, and presence of steatosis by ultrasonography were recorded. The risk of developing hepatic fibrosis and steatosis was calculated with the non-alcoholic fatty liver disease liver fat score (NAFLD-LFS), hepatic steatosis index (HSI), fatty liver index (FLI), fibro- sis-4 index (FIB-4), NAFLD fibrosis score (NAFLD-FS), and aspartate aminotransaminase to platelet ratio index (APRI). The conclusions were evaluated with SPSS. Results: According to the diagnostic criteria, MAFLD was detected in 58.4% of the participants. Statistically significant difference was found between FLI, HSI, NAFLD-LFS and MAFLD (p<0.001). According to the steatosis index risk groups of the participants, 64.4% - 89.7% were found to be high-risk. Steatosis was confirmed by ultrasonography in 63.6% - 77.8% of those at high-risk for index stea- tosis. The statistically significant difference was found between hypertension, diabetes mellitus, hyperlipidemia, metabolic syndrome, obesity, and MAFLD (p=0.039, p<0.001, p<0.001, p<0.001, and p=0.011, respectively). Conclusion: Using non-invasive screening methods for steatosis can be clinically useful in detecting patients at risk for steatosis, and these methods are applicable in predicting MAFLD. Key Words: NAFLD, Fatty liver ındex, Hepatic steatosis index, MAFLD, Steatosis. How to cite this article: Balci IC, Haciagaoglu N, Oner C, Cetin H, Simsek EE. Non-invasive Screening of Metabolic Associated Fatty Liver Disease and Affecting Factors in Primary Care. J Coll Physicians Surg Pak 2023; 33(04):390-395. INTRODUCTION The prevalence of fatty liver disease (Non-Alcoholic Fatty Liver Disease,NAFLD)isincreasing,itsincidenceisestimatedat25% worldwide. 1 Even if fat is present in more than 5% of the liver weight in NAFLD, there is no inflammation or cell damage. However, in NASH (Non-Alcoholic Steatohepatitis), fat is together with inflammation and cell damage. Additionally, fibrosis can be present in NASH. 2 Although NAFLD is unlikely to progress to cirrhosis, cirrhosis may develop in NASH in the following years. Due to its insulin resistance status in its patho- genesis, NAFLD is associated with metabolic syndrome and obesity.Italsoplaysaroleinexacerbatingthepathophysiology of atherosclerosis, type 2 diabetes mellitus (DM), cardiovas- cular diseases, and chronic kidney disease. 3 Correspondence to: Dr. Idil Ceren Balci, Department of Family Medicine, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Kartal, Istanbul, Turkiye E-mail: cerengedik.54@gmail.com ..................................................... Received: November 14, 2022; Revised: March 11, 2023; Accepted: March 27, 2023 DOI: https://doi.org/10.29271/jcpsp.2023.04.390 This disease group was evaluated in the form of NAFLD and NASH since its first definition. It has a close relationship with metabolic dysfunction and heterogeneous pathogenesis. Because of the inaccuracies in terminology, the NAFLD defini- tion should be reconsidered as a new comprehensive term. In 2020, experts from 22 countries proposed to change the defini- tion of NAFLD to "metabolic associated fatty liver disease (MAFLD)" with a consensus. The diagnosis of MAFLD better reflects metabolic diseases as a new definition that is both simpleandcomprehensive,independentofotherliverdiseases and to better explains the complex aetiology and heteroge- neous pathogenesis of the fatty liver disease. In the MAFLD diag- nostic criteria, any imaging method, non-invasive scores, or liverfatteningwithatleastabiopsyindicatedMAFLDifpatients are overweight or have DM. However, at least two metabolic risks were sought for patients with normal weight. 4-6 Although there are many non-invasive imaging methods for diagnosis, the gold standard is a liver biopsy. The first imaging method performed in suspected high-risk patients is liver ultra- sonography. The non-invasive screening method used in hepatic fibrosis examination is ultrasound elastography. Diet and exercise form the basis of treatment. 7