ABSTRACT Objective: To evaluate the association between subclinical hypothyroidism and hepatic steatosis and fibrosis using the noninvasive diagnostic methods transient hepatic elastography (TE) and controlled attenuation parameter (CAP) in patients with subclinical hypothyroidism. Subjects and methods: This was a cross-sectional study including women with confirmed spontaneous subclinical hypothyroidism and an age- and body mass index (BMI)-matched control group without thyroid disease or circulating antithyroperoxidase (anti-TPO) antibodies. Exclusion criteria were age > 65 years, thyroid-stimulating hormone (TSH) > 10.0 mIUI/L, BMI ≥ 35 kg/m2, diabetes, or other chronic liver diseases. Liver stiffness was classified according to TE values (in kPa) and ranged from absence of fibrosis (F0) to advanced fibrosis (F3). Hepatic steatosis was classified according to CAP values (in dB/m) and ranged from low-grade (S1) to advanced (S3) steatosis. Results: Of 68 women enrolled, 27 were included in the subclinical hypothyroidism group and 41 in the control group. Advanced steatosis (S3) was more frequent in the subclinical hypothyroidism group (25.9% versus 7.3%, respectively, p = 0.034). Circulating anti-TPO was an independent factor associated with advanced steatosis (odds ratio 9.5, 95% confidence interval 1.3–68.3). In multiple linear regression analysis, TE values (which evaluated fibrosis) correlated negatively with free thyroxine levels. Conclusion: The results of this study strengthen the hypothesis that hepatic steatosis is associated with autoimmune (positive anti-TPO) subclinical hypothyroidism, independently from BMI. However, subclinical hypothyroidism alone does not appear to be associated with a significantly increased risk of hepatic fibrosis. Objective (TE (CAP crosssectional cross sectional BMImatched matched antiTPO anti TPO (anti-TPO antibodies 6 years thyroidstimulating stimulating TSH (TSH 100 10 0 10. mIUIL mIUI L mIUI/L 3 kgm2 kgm kg m2 m kg/m2 diabetes diseases kPa F0 F (F0 F3. F3 . (F3) dB/m dBm dB lowgrade low grade S1 S (S1 S3 (S3 Results enrolled 2 4 25.9% 259 25 9 (25.9 73 7 7.3% respectively 0.034. 0034 0.034 034 0.034) odds 95 5 9.5 1.3–68.3. 13683 1.3–68.3 1 1.3–68.3) analysis which levels Conclusion positive However kg/m (F (F3 (S 25.9 (25. 7.3 003 0.03 03 9. 1368 1.3–68. 25. (25 7. 00 0.0 136 1.3–68 (2 0. 13 1.3–6 ( 1.3– 1.3 1.

ABSTRACT Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as Nonalcoholic fatty liver disease (NAFLD), is one of the most common hepatic diseases in individuals with overweight or obesity. In this context, a panel of experts from three medical societies was organized to develop an evidence-based guideline on the screening, diagnosis, treatment, and follow-up of MASLD. Material and methods: A MEDLINE search was performed to identify randomized clinical trials, meta-analyses, cohort studies, observational studies, and other relevant studies on NAFLD. In the absence of studies on a certain topic or when the quality of the study was not adequate, the opinion of experts was adopted. Classes of Recommendation and Levels of Evidence were determined using prespecified criteria. Results: Based on the literature review, 48 specific recommendations were elaborated, including 11 on screening and diagnosis, 9 on follow-up, 14 on nonpharmacologic treatment, and 14 on pharmacologic and surgical treatment. Conclusions: A literature search allowed the development of evidence-based guidelines on the screening, diagnosis, treatment, and follow-up of MASLD in individuals with overweight or obesity. Introduction dysfunctionassociated dysfunction associated MASLD, , (MASLD) NAFLD, NAFLD (NAFLD) obesity context evidencebased evidence based diagnosis treatment followup follow up methods trials metaanalyses, metaanalyses meta analyses, analyses meta-analyses adequate adopted criteria Results review 4 elaborated 1 followup, up, Conclusions (MASLD (NAFLD