Fatty liver index VS FIBROSCAN (Vibration controlled transient elastography ) in diagnosis of Metabolic dysfunction associated fatty liver disease -Balancing accuracy and accessibility in the Indian context

Metabolic Dysfunction Associated Fatty Liver Disease MAFLD, formerly known as Non-Alcoholic Fatty Liver Disease  NAFLD , is a significant global health challenge, affecting about a quarter of the worlds adult population. This high prevalence, fueled by sedentary lifestyles, low physical activity, and unhealthy diets, poses a major health and economic burden.MAFLD is defined by hepatic steatosis diagnosed via histology, imaging, or blood biomarkers alongside at least one of three criteria  overweight/obesity, type 2 diabetes mellitus (T2DM), or evidence of metabolic dysregulation (defined by at least two specific metabolic risk abnormalities like elevated waist circumference, blood pressure, triglycerides, low HDL cholesterol, prediabetes, high HOMA IR, or elevated C reactive protein). For diagnosis of hepatic steatosis while ultrasonography  is a first-line tool, it is subjective and operator-dependent. Liver biopsy, though a gold standard, is invasive, costly, carries risks, and is unsuitable for screening .These limitations highlight the critical need for simple, non-invasive diagnostic tools.Among serum based non-invasive tests , the Fatty Liver Index is considered appropriate due to its diagnostic and prognostic performance. FLI is a simple algorithm derived from readily available parameters such as Body Mass Index , waist circumference, serum triglycerides, and gamma-glutamyl transferase  levels.HeFibroScan which assesses liver stiffness (fibrosis) and hepatic steatosis (via Controlled Attenuation Parameter, CAP), is another non-invasive option. While effective, FibroScan is relatively expensive, requires specialized equipment and trained operators, and can be influenced by factors like obesity. Hence  the present study aims to determine the prevalence of MAFLD and evaluate the diagnostic performance of FLI compared to FibroScan for detecting fatty liver in adults attending a tertiary care hospital in Telangana, India.