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CN 22-1108/R
Volume 42 Issue 6
Jun.  2026
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Article Navigation >  Journal of Clinical Hepatology  > 2026  >  42(6): 1294-1300

Application value of fibrosis-4 index and liver transient elastography in liver fibrosis risk stratification for metabolic associated fatty liver disease in community health institutions

DOI: 10.12449/JCH260610
  • 1.

    Fatty Liver Disease Treatment Center，Beijing YouAn Hospital，Capital Medical University，Beijing 100069，China

  • 2.

    Beijing Baizhifang Community Health Service Center，Beijing 100054，China

Research funding:

National Major Science and Technology Project (2023ZD0508700);

National Major Science and Technology Project (2023ZD0508703);

Capital’s Funds for Health Improvement and Research (2023-2S-003);

Scientific Research Project of Beijing Youan Hospital (BJYAYY-YN2025-19);

Beijing High-Level Public Health Technical Personnel Training Program (03-23);

Beijing Municipal Administration of Hospitals Incubating Program (PX2023061)

More Information
  • Corresponding author: CAO Li， caoli1983@163.com （ORCID： 0009-0006-3714-3672）; QIU Lixia， qiulixia@ccmu.edu.cn （ORCID： 0000-0001-9662-8705）
  • Received Date: 2025-12-28
  • Accepted Date: 2026-03-09
  • Published Date: 2026-06-25
    Abstract
  •   Objective  To perform metabolic associated fatty liver disease （MAFLD） screening among individuals attending community health institutions， to identify the patients at a low， moderate or high risk of advanced liver fibrosis based on fibrosis-4 index （FIB-4） and liver stiffness measurement （LSM） measured by liver transient elastography， and to implement stratified management.  Methods  A cross-sectional study was conducted among 630 individuals attending Beijing Baizhifang Community Health Service Center from January to July 2024， and they were divided into MAFLD group and non-MAFLD group. According to body mass index （BMI）， the MAFLD group was further divided into lean MAFLD group （BMI<23 kg/m2） and non-lean MAFLD group （BMI≥23 kg/m2）. The above groups were compared in terms of demographic features， laboratory markers， hepatic steatosis， and LSM. Fibrosis risk stratification was performed for MAFLD patients based on FIB-4 and LSM， and a closed-loop management system involving referral to tertiary hospitals and follow-up at community health institutions was implemented. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups.  Results  There were 445 individuals （70.6%） in the MAFLD group and 185 individuals （29.4%） in the non-MAFLD group. Compared with the non-MAFLD group， the MAFLD group had a significantly lower proportion of male individuals （χ2=4.299， P<0.05）， a significant reduction in the level of high-density lipoprotein cholesterol （Z=3.484， P<0.05）， and significant increases in body weight （Z=-7.366， P<0.05）， BMI （Z=-9.740， P<0.05）， waist circumference （Z=-6.397， P<0.05）， hip circumference （Z=-6.935， P<0.05）， alanine aminotransferase （ALT） （Z=-2.765， P<0.05）， fasting blood glucose （Z=-3.646， P<0.05）， triglyceride （TG） （Z=-6.569， P<0.05）， total cholesterol （Z=-2.033， P<0.05）， low-density lipoprotein cholesterol （Z=-2.935， P<0.05）， controlled attenuation parameter （CAP） （Z=-19.784， P<0.05）， and LSM （Z=-5.703， P<0.05）. Within the MAFLD group， there were 124 individuals （27.9%） in the lean MAFLD group and 321 individuals （72.1%） in the non-lean MAFLD group. Compared with the non-lean MAFLD group， the lean MAFLD group had significantly lower body weight （Z=-12.414， P<0.05）， BMI （Z=-16.363， P<0.05）， waist circumference （Z=-7.733， P<0.05）， hip circumference （Z=-8.595， P<0.05）， ALT （Z=-2.835， P<0.05）， aspartate aminotransferase （Z=-1.972， P<0.05）， TG （Z=-2.407， P<0.05）， CAP （Z=-4.429， P<0.05）， degree of steatosis （χ2=16.588， P<0.05）， and LSM （Z=-3.908， P<0.05）. Based on the results of FIB-4 and LSM， 76 patients at a moderate or high risk of liver fibrosis should be referred to a higher-level hospital for further management.  Conclusion  The detection rate of MAFLD reaches 70.6% among the individuals attending community health institutions， among whom 76 （17.1%） should be referred to a higher-level hospital. Establishing a liver fibrosis risk stratification and management system based on FIB-4 and LSM among MAFLD individuals in communities provides a practical pathway for chronic disease management and referral system construction in community health institutions.

     

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