# Sustainability of General Population Screening for Steatotic Liver Disease: A Proof-of-Concept Study

## TL;DR

This study shows that large-scale screening for fatty liver disease is feasible and can help identify people at risk based on factors like BMI and lifestyle.

## Contribution

The study demonstrates the feasibility and sustainability of population-based screening for steatotic liver disease using ultrasound parameters.

## Key findings

- Elevated liver stiffness and ultrasound attenuation are strongly associated with BMI and waist circumference.
- Hypertension is linked to higher liver stiffness, while sugary coffee and alcohol intake correlate with higher ultrasound attenuation.
- Population screening for fatty liver disease is feasible and can identify individuals at risk for advanced liver disease.

## Abstract

Background: Steatotic liver disease (SLD) is a growing global health concern and may progress to more advanced liver diseases (i.e., fibrosis, cirrhosis, and hepatocellular carcinoma). Early identification of individuals at risk through effective screening strategies is crucial for timely intervention and management. The aim of this population-based study was to evaluate the feasibility of mean/large-scale screening and its importance by analyzing key risk factors, such as metabolic and lifestyle-related determinants. Methods: This cross-sectional study involved 387 subjects aged 18 to 89 years in a remote rural area that stretches among the valleys at the foot of the Apennines and the Apuan Alps. Anthropometric and demographic data were recorded, together with the measurement of blood pressure and cardiac rhythm. Furthermore, US-based liver stiffness (LS) and the ultrasound attenuation parameter (UAP) using the ILivTouch (Hisky Medical, Wuxi, China) device were performed. All data were analyzed with SPSS version 28. Univariate and multivariate analyses were conducted to identify significant predictors of both LS and UAP. Results: Significant associations are observed between elevated LS and UAP values and risk factors, such as BMI and waist circumference (BMI and waist with R = 0.45 and R = 0.34, R = 0.29 and R = 0.28; respectively, for UAP and LS; all with p < 0.001). The presence of hypertension is associated with a high value of LS (p < 0.05), and high UAP with alcohol consumption and sugary coffee intake habit (p < 0.001 and, p < 0.05, respectively). Conclusions: General population screening for SLD is feasible, sustainable, and useful to identify both individuals at risk and patients with progressive liver disease.