Comparison of diagnostic performance between FIB‐4 and NFS in metabolic‐associated fatty liver disease era

Aims Fibrosis‐4 index (FIB‐4) and non‐alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) are the two most widely used non‐invasive tools for screening of advanced fibrosis in subjects with NAFLD. Since metabolic dysfunction‐associated fatty liver disease (MAFLD) has been proposed as a new category of fatty liver disease, we aimed to compare the diagnostic performance of FIB‐4 and NFS in subjects with MAFLD and in various subgroups. Methods This study was designed as cross‐sectional study. Data from 6775 subjects who underwent magnetic resonance elastography (MRE) and abdominal ultrasonography at the same time during a health check‐up at 13 various health check‐up centers were retrospectively reviewed. Advanced fibrosis was defined as an MRE value of ≥3.6 kPa. Results The area under the receiver operating characteristic curves (AUROCs) of FIB‐4 and NFS for diagnosing advanced fibrosis were similar in subjects with MAFLD. However, the AUROC of NFS was lower than that of FIB‐4 in the diabetic subgroup of MAFLD (0.809 in FIB‐4 vs. 0.717 in NFS, p = 0.002). The performances of both FIB‐4 and NFS were poor in the subgroup of MAFLD with significant alcohol intake. Conclusions The overall diagnostic performance of FIB‐4 and NFS for diagnosing advanced fibrosis did not differ among subjects with MAFLD. However, the performance of NFS was lower in the diabetes subgroup of MAFLD. The diagnostic performance of FIB‐4 was better for fibrosis in various subgroups of MAFLD.