Letter to the editor June 10, 2024 June 10, 2024

Fibrosis or steatosis: which is the best screening target? Comment on the Brazilian evidence-based guideline for screening, diagnosis, treatment, and follow-up of metabolic dysfunction-associated steatotic liver disease (MASLD) in adult individuals with overweight or obesity

DOI: 10.20945/2359-4292-2024-0014

Screening strategies are interesting for highly prevalent diseases with a detectable preclinical phase, beneficial therapeutic options, and accurate and cost-efficient screening tests. However, the screening strategy proposed in the “Brazilian evidence-based guideline for screening, diagnosis, treatment, and follow-up of metabolic dysfunction-associated steatotic liver disease (MASLD) in adult individuals with overweight or obesity” is quite problematic, as it focuses primarily on detecting steatosis ().

The sensitivity of abdominal ultrasound in detecting moderate to severe hepatic steatosis is only 84.5% (95% confidence interval [CI] 79.5%-88.9%), which is insufficient to consider this a good screening test (). Furthermore, both vibration-controlled transient elastography with controlled attenuation parameter and magnetic resonance imaging with proton density fat fraction, known for their higher sensitivity, are rarely available and have a high cost.

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