Abstract

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD), recently renamed metabolic dysfunction–associated steatotic liver disease (MASLD), is highly prevalent yet frequently underdiagnosed in primary care. Early recognition of advanced fibrosis is crucial to reduce liver-related morbidity and mortality. This review assessed the diagnostic accuracy and effectiveness of NAFLD screening methods in primary care and family medicine.
METHODS: This review was recorded in PROSPERO (CRD420261283357) and carried out in accordance with the PRISMA-DTA 2020 statement and Cochrane Handbook recommendations. English-language studies involving adults (≥18 years) screened for NAFLD in primary care or family medicine clinics were found by searching MEDLINE (PubMed), Scopus, Web of Science, and Google Scholar. Eligible studies included randomized controlled trials, diagnostic accuracy studies, cohort studies, and economic evaluations. Screening tools included blood-based scores (FIB-4, NAFLD Fibrosis Score) and imaging modalities (ultrasound, transient elastography, and magnetic resonance elastography). Eleven studies were included.
RESULTS: Although sensitivity and specificity varied, blood-based scores showed high negative predictive values (90.7%–99.1%) for ruling out advanced fibrosis (F3–F4). Strong diagnostic accuracy (AUROC up to 0.92) and consistently high sensitivity (83%–98%) were demonstrated using transient elastography (FibroScan). Magnetic resonance elastography achieved the highest accuracy (AUROC 0.94) but was less accessible in primary care. Conventional ultrasound was effective for detecting steatosis but inadequate for fibrosis staging.
CONCLUSION: Blood-based non-invasive scores are effective first-line tools for excluding advanced fibrosis in primary care, while FibroScan provides superior fibrosis risk stratification. Ultrasound alone is insufficient, and a stepwise biomarker–elastography approach may improve early detection and referral.

Key words: NAFLD, screening, family medicine, clinics, Saudi Arabia, systematic review