Fatty Liver and Pancreatic Steatosis

The purpose of this study is to evaluate the association between non-alcoholic fatty liver disease and non-alcoholic pancreatic steatosis and to describe cytokine levels in the context of a global epidemic of obesity and metabolic syndrome, which could represent a new treatment target in previously underdiagnosed patients with pancreatic insufficiency and pancreatic steatosis.

Patients over 18 years old with a diagnosis of MAFLD (Metabolic Dysfunction-Associated Fatty Liver Disease) will undergo the following assessments:

• Exocrine Pancreatic Insufficiency Questionnaire (PEI-Q)
• Measurement of weight, height, and abdominal circumference
• Fecal elastase (Fel-1)
• Pro-inflammatory and anti-inflammatory cytokines in serum
• Hydrogen and methane breath tests to evaluate small intestinal bacterial overgrowth (SIBO)
• Endoscopic ultrasound with sedation
• Fibroscan Exocrine pancreatic insufficiency (EPI) will be defined as a fecal elastase-1 (Fel-1) concentration of < 100 µg/g or Fel-1 between 100 and 200 µg/g with alterations in additional pancreatic pathology tests, such as serum albumin, vitamin E, vitamin D, vitamin A, folic acid, iron, transferrin, calcium, magnesium, and/or malnutrition identified through anthropometric measurements conducted by an expert nutritionist. Fel-1 ≥ 200 µg/g will be considered normal.

Additionally, for those patients with fecal elastase levels below 200 µg/g, the following measurements will be conducted:

• Proteinogram
• Vitamin E, vitamin D, vitamin A, vitamin K
• Folic acid, B12
• Calcium, magnesium, zinc
• Iron profile
• Nutritional assessment with anthropometry

For those with exocrine pancreatic insufficiency (EPI):

• IgG4
• Alpha-1 antitrypsin
• Endoscopic ultrasound (EUS) with biopsies

Inclusion criteria

• Patients over 18 years old with a diagnosis of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD).

Exclusion criteria

• - Alcohol consumption >20 g/day in women, >30 g/day in men
• Chronic hepatitis B or C infection
• Autoimmune liver diseases: autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis
• Hereditary hemochromatosis
• Wilson's disease
• Alpha-1 antitrypsin deficiency
• Celiac disease
• Uncontrolled thyroid disease
• Active or chronic infectious disease
• Active cancer or ongoing treatment
• Chronic renal insufficiency
• Pregnancy/lactation
• Insufficient data
• Patients who do not complete follow-up