{
  "abstract": "Background Metabolic dysfunction–associated steatotic liver disease (MASLD) is increasingly recognized as a major cause of chronic liver disease; however, fibrosis assessment in routine practice is often deferred until overt diabetes develops. Prediabetes represents an intermediate metabolic state that is highly prevalent but frequently overlooked in liver risk stratification. This study aimed to evaluate the burden of advanced liver fibrosis among non-diabetic MASLD patients with prediabetes and to assess the clinical utility of non-invasive tools for early risk identificationMethods In this cross-sectional study, 107 non-diabetic MASLD patients were enrolled at a tertiary referral center between 2024 and 2025. Prediabetes was defined using standard glycemic criteria. Liver fibrosis was assessed by the FIB-4 index and Acoustic Radiation Force Impulse (ARFI) elastography. The prevalence of significant (F≥2) and advanced fibrosis (F≥3) was determined, and factors associated with advanced fibrosis were analyzed.Results The mean age was 47.3 ± 12.6 years, and 56.1% of patients were male. Significant fibrosis (F≥2) and advanced fibrosis (F≥3) were present in 15.0% and 11.3% of patients, respectively. FIB-4 demonstrated excellent discrimination for advanced fibrosis, with an AUROC of 0.949 for F≥3. Notably, among patients with prediabetes, 41.7% already had advanced fibrosis, highlighting prediabetes as an early warning clinical state in which fibrosis may already be established. Age and AST level were independent predictors of advanced fibrosis.Conclusions Prediabetes is associated with a substantial burden of advanced liver fibrosis in non-diabetic MASLD patients. These findings suggest that waiting for the onset of overt diabetes may delay fibrosis detection. Incorporating simple non-invasive tools such as FIB-4 and ARFI elastography into the evaluation of prediabetic individuals may support earlier risk stratification and timely preventive intervention in routine clinical practice.",
  "authors": [
    {
      "affiliations": [
        "Center for Gastrointestinal Endoscopy and Laparoscopic Surgery, Vietnam"
      ],
      "name": "Van Trung Huynh"
    },
    {
      "affiliations": [
        "Center for Gastrointestinal Endoscopy and Laparoscopic Surgery, Vietnam"
      ],
      "name": "Khanh Cong Pham"
    },
    {
      "affiliations": [
        "Center for Gastrointestinal Endoscopy and Laparoscopic Surgery, Vietnam"
      ],
      "name": "Phuong Hoai Huynh"
    },
    {
      "affiliations": [
        "Center for Gastrointestinal Endoscopy and Laparoscopic Surgery, Vietnam"
      ],
      "name": "Long Hoang Doan"
    },
    {
      "affiliations": [
        "Center for Gastrointestinal Endoscopy and Laparoscopic Surgery, Vietnam"
      ],
      "name": "Thanh Dinh Hoang"
    },
    {
      "affiliations": [
        "Center for Gastrointestinal Endoscopy and Laparoscopic Surgery, Vietnam"
      ],
      "name": "Ngan Thanh Quynh Le"
    }
  ],
  "title": "IDDF2026-ABS-0012 Prediabetes as an early warning signal for advanced fibrosis in non-diabetic MASLD patients: a non-invasive risk stratification study",
  "uid": "c6ae56db-cee0-5da7-a6cc-d1cc5731ea9d"
}