Role of total bile acid trajectories in MAFLD development and progression

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Created On: 15/11/2025

The longitudinal link between metabolic dysfunction-associated fatty liver disease (MAFLD) and total bile acid (TBA) levels is not well-established.

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Key take away

High-stable total bile acid trajectories are consistently linked with a greater risk of developing MAFLD and progression to advanced fibrosis, highlighting their potential role as predictive biomarkers.

Background

The longitudinal link between metabolic dysfunction-associated fatty liver disease (MAFLD) and total bile acid (TBA) levels is not well-established. This retrospective cohort study examined whether distinct TBA trajectories are linked with incident MAFLD and progression of liver fibrosis.

Method

A cohort of 3,259 adults who underwent at least 3 health assessments at a hospital was analyzed. MAFLD was detected via abdominal ultrasound. Fibrosis was evaluated via the fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS). Logistic and multinomial regression models assessed the connection between TBA trajectories, new-onset MAFLD, and fibrosis status.

Result

Over follow-up, 715 volunteers developed MAFLD; among them, 15.1% had elevated NFS and 12.2% had elevated FIB-4 scores. In comparison with the low-stable TBA group, those with high-stable TBA trajectories showed a considerably heightened risk of developing MAFLD (adjusted odds ratio [OR] = 1.448). Subgroup analyses substantiated the robustness of these outcomes. High-stable TBA patterns were also independently related to advanced fibrosis, both by NFS (adjusted OR = 2.435) and FIB-4 (adjusted OR = 3.194).

Conclusion

Persistent elevation of TBA was strongly linked with MAFLD development and with advanced liver fibrosis. These findings underscore the potential role of TBA trajectories as biomarkers for identifying those at heightened risk of MAFLD progression.