Evidence of Pancreatic Exocrine Insufficiency in patients with Metabolic Associated Fatty Liver Disease patients

Abstract Background Pancreatic exocrine insufficiency (PEI) is increasingly recognized in patients with metabolic-associated fatty liver disease (MAFLD), particularly those with metabolic comorbidities such as diabetes mellitus (DM). However, limited data exist on the prevalence and clinical implications of PEI in MAFLD. Patients and Methods: This prospective, case-control study included 70 MAFLD patients and 20 healthy controls. All participants underwent clinical assessment, anthropometric measurements, laboratory testing, liver imaging (Fibroscan with CAP score), and fecal pancreatic elastase-1 (FPE-1) testing. PEI was defined as FPE-1 < 200 µg/g. Subgroup analyses were performed comparing MAFLD patients with and without PEI, and with and without diabetes. Logistic regression identified independent predictors of PEI. Results MAFLD patients had significantly lower FPE-1 levels compared to controls (180.38 ± 26.80 µg/g vs. 240.12 ± 43.39 µg/g, p < 0.001). PEI was present in 84.3% of MAFLD patients. Patients with PEI had significantly higher HbA1c (7.65 ± 2.47% vs. 5.78 ± 2.13%, p = 0.042) and waist circumference (115.73 ± 9.70 cm vs. 110.36 ± 5.95 cm, p = 0.043). Among MAFLD patients with diabetes, PEI prevalence was higher (90.0% vs. 82.0%, p = 0.039), and FPE-1 levels were significantly lower (163.47 ± 19.83 µg/g vs. 187.54 ± 26.92 µg/g, p = 0.001). These patients also showed more severe metabolic derangements and advanced liver disease. Multivariate analysis identified MAFLD as an independent predictor of PEI (OR = 10.220, p = 0.008). Conclusion PEI is highly prevalent in MAFLD patients, particularly those with diabetes and poor metabolic control. Fecal elastase testing may be a useful tool for early identification of PEI in this population.