# Clinical utility of the MAF-5 score for assessing MAFLD/MASLD in a Japanese population with obesity

## TL;DR

The MAF-5 score is a useful noninvasive tool for predicting liver fibrosis in Japanese patients with MASLD, even among those with type 2 diabetes.

## Contribution

This study evaluates the MAF-5 score's clinical utility in Japanese MASLD patients, including those with diabetes, for the first time.

## Key findings

- The MAF-5 score significantly correlated with liver stiffness measurement (LSM) in Japanese MASLD patients.
- The MAF-5 score outperformed the FIB-4 index in predicting significant liver fibrosis.
- The MAF-5 score's predictive value was consistent regardless of diabetes status.

## Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) coexists with type 2 diabetes and is rising in Japan. Liver fibrosis progression in MASLD causes adverse outcomes, highlighting the need for early risk stratification. The utility of the Metabolic Dysfunction–Associated Fibrosis 5 (MAF-5) score has not been assessed in Japanese populations, especially among individuals with type 2 diabetes. Herein, the clinical relevance of the MAF-5 score was assessed in Japanese patients with MASLD.

This prespecified secondary analysis used data from a study titled “A Study to Estimate the Severity of MAFLD Using Continuous Glucose Monitoring.” Sixty-six patients diagnosed with metabolic dysfunction–associated fatty liver disease (MAFLD) underwent vibration-controlled transient elastography. All participants were subsequently confirmed to meet the revised diagnostic criteria for MASLD. The MAF-5 score and FIB-4 index were calculated for each participant. Correlations between these scores and liver stiffness measurement (LSM) were assessed using Spearman’s rank correlation coefficient. Significant fibrosis was defined as LSM ≥ 8.0 kPa. The predictive performance of each score was evaluated using the area under the receiver operating characteristic curve (AUROC).

The final analysis included 57 participants (28 with type 2 diabetes). The MAF-5 score significantly correlated with LSM, whereas the FIB-4 index did not. These associations were consistent regardless of diabetes status. The AUROC for the MAF-5 score was higher than that for the FIB-4 index.

The MAF-5 score may serve as a useful noninvasive marker for predicting liver fibrosis in Japanese patients with MASLD, regardless of diabetes status.