# Prevalence of Controlled Attenuation Parameter (CAP)-Assessed Hepatic Steatosis as a Possible Indicator of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) Risk in Healthy Medical Students: A Cohort Study From South India

## TL;DR

This study found that nearly a quarter of healthy South Indian medical students showed signs of liver fat, suggesting early detection tools like CAP could help identify fatty liver disease risks.

## Contribution

The study provides new prevalence data on hepatic steatosis in young, healthy adults using CAP measurements in a South Indian cohort.

## Key findings

- 23.1% of participants had CAP-assessed hepatic steatosis (CAP ≥238 dB/m).
- CAP values correlated strongly with BMI, waist, and hip circumference.
- BMI was the only independent predictor of CAP in multivariable analysis.

## Abstract

Background: The prevalence of hepatic steatosis is increasing worldwide, and it is now recognized as a leading hepatic sign of metabolic syndrome. The optimal approach for screening hepatic steatosis in asymptomatic populations remains unclear. The controlled attenuation parameter (CAP), measured via transient elastography, has emerged as a non-invasive, reliable tool for quantifying liver fat. Our study aimed to determine the prevalence of CAP-assessed hepatic steatosis among healthy medical students in South India.

Methods: In this cohort study, 688 medical students aged ≥18 years with no significant alcohol consumption underwent transient elastography (FibroScan®; Echosens, Paris, France) to assess liver stiffness measurement (LSM) and CAP. Hepatic steatosis was defined as CAP ≥238 dB/m. Anthropometric parameters were recorded, and correlations with CAP were evaluated using Spearman’s coefficient. Independent predictors were identified via multivariable linear regression.

Results: The mean participant age was 20.5 ± 1.1 years; 60.6% were female. The prevalence of CAP-assessed liver steatosis, defined as CAP ≥238 dB/m, was 23.1% (n=159). CAP values showed significant correlations with body mass index (BMI) (r=0.38, p<0.001), waist circumference (r=0.37, p<0.001), and hip circumference (r=0.32, p<0.001). Multivariable analysis identified BMI as the only independent predictor of CAP (β=4.78, p<0.001).

Conclusion: The findings of this study show that hepatic steatosis is prevalent even among young, evidently healthy adults. CAP measurement using FibroScan cannot substitute for a full MAFLD diagnosis without metabolic criteria; however, it can be an effective, non-invasive tool for early detection of hepatic steatosis and may have utility in screening asymptomatic populations.