Background: Despite the association of insulin resistance (IR) in the pathophysiology of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), few studies have evaluated the utility of acanthosis nigricans (AN) as a clinical predictor for this condition. Thus, we aimed to determine the role of AN as a risk factor and clinical predictor of MASLD.
Methods: This cross-sectional study conducted a comprehensive clinical history and physical examination. The presence of acanthosis nigricans was assessed in the neck, elbows, axillae, and knuckles. Liver biochemical parameters were measured, hepatic fat was analyzed using the controlled attenuation parameter (CAP), while hepatic stiffness was evaluated in kilopascals (kPA) with the FibrosScan 530 Compact and Smart Exam software. Multiple analyses were performed to determine the relationship between acanthosis nigricans and MASLD.
Results: We recruited 251 adult participants. The mean BMI was 29.9 ± 7.3 kg/m2, including 40.2% of participants with obesity and 63.7% with AN. Transient elastography evaluation resulted in 65.7% and 6% participants with hepatic steatosis (S3, 48.6%) and fibrosis, respectively. A non-adjusted (OR 2.63, 95% CI 1.57-4.52) and adjusted model (OR 1.97, 95% CI 0.95-4.12) were determined for AN as a risk factor for liver steatosis. Furthermore, the presence of AN in knuckles resulted in an association to predict liver steatosis (OR 2.09, 95% CI 1.01-4.35), while a multivariate analysis indicated that AN predicts a higher steatosis grade (S2 OR = 6.58, CI 95% 1.18-36.53; S3 OR = 2.36, CI 95% 1.04-5.3).
Conclusions: Acanthosis nigricans demonstrated to predict a higher steatosis grade in adults with overweight and obesity. Our study supports the clinical applicability of AN as a screening tool for MASLD to identify high-risk subjects in resource-limited settings. Additional studies are needed to define alternative diagnostic tools for the early identification of metabolic risk factors in populations with specific clinical or demographic characteristics.
Keywords: MASLD; acanthosis nigricans; fibrosis; liver; steatosis.
Plain language summary
Clinical applicability of acanthosis nigricans as a screening tool for liver health evaluation This study investigates the potential of acanthosis nigricans (AN) as a clinical predictor for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). Conducted with 251 adult participants, the study assessed the presence of AN and evaluated liver health through biochemical and physical measurements. Results indicated a significant association between AN and higher grades of liver steatosis, particularly in overweight and obese individuals. The study supports the use of AN as a cost-effective screening tool for MASLD in resource-limited settings, though further research is recommended to explore additional diagnostic methods. This research is significant because it evaluates the role of acanthosis nigricans (AN) as a clinical predictor for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), a prevalent condition linked to obesity and insulin resistance. Understanding the association between AN and MASLD can enhance early detection and intervention strategies, especially in resource-limited clinical settings where advanced diagnostic tools may not be available. The study’s findings highlight the potential of using AN as a simple, non-invasive screening tool to identify individuals at high risk for MASLD, which could lead to timely management and better health outcomes. The study emphasizes the need for further research to develop alternative diagnostic tools tailored to populations with specific clinical or demographic characteristics, such as the Latin American population, where the prevalence of overweight, and obesity is rising.
© The Author(s) 2025.
Keywords：acanthosis nigricans; metabolic dysfunction; steatotic liver disease
背景： 尽管胰岛素抵抗（IR）与代谢功能障碍相关性肝脂肪变性疾病（MASLD）的病理生理学有关，但很少有研究评估黑棘皮病（AN）作为该疾病的临床预测指标的实用性。因此，我们旨在确定AN作为MASLD风险因素和临床预测因子的作用。
方法： 这项横断面研究进行了全面的临床史和体格检查。在颈部、肘部、腋窝和指关节处评估了黑棘皮病的存在情况。测量肝脏生化参数，使用受控衰减参数（CAP）分析肝脂肪含量，并通过FibroScan 530 Compact和Smart Exam软件以千帕斯卡（kPa）为单位评估肝硬度。进行多项分析以确定黑棘皮病与MASLD之间的关系。
结果： 我们招募了251名成年参与者。平均BMI为29.9 ± 7.3 kg/m²，其中40.2%的参与者患有肥胖症，63.7%的参与者有黑棘皮病。瞬时弹性图评估结果显示，65.7%和6%的参与者分别存在肝脂肪变性（S3阶段占48.6%）和纤维化。未调整模型（OR 2.63，95% CI 1.57-4.52）和调整后的模型（OR 1.97，95% CI 0.95-4.12）确定了黑棘皮病作为肝脂肪变性风险因素的作用。此外，在指关节处出现黑棘皮病与预测肝脂肪变性的关联显著（OR 2.09, 95% CI 1.01-4.35），而多变量分析表明，黑棘皮病可预测更高的脂肪变性程度（S2阶段 OR = 6.58，CI 95% 1.18-36.53；S3阶段 OR = 2.36, CI 95% 1.04-5.3）。
结论： 黑棘皮病显示可预测成人超重和肥胖患者更高的肝脂肪变性程度。我们的研究支持将黑棘皮病作为MASLD筛查工具的临床适用性，以在资源有限的情况下识别高危人群。需要进一步的研究来定义用于早期识别特定临床或人口统计学特征人群中代谢风险因素的替代诊断方法。
关键词： MASLD；黑棘皮病；纤维化；肝脏；脂肪变性。
简易语言摘要
临床应用——黑棘皮病作为评估肝健康的筛查工具。这项研究调查了黑棘皮病（AN）作为代谢功能障碍相关性肝脂肪变性疾病（MASLD）的临床预测指标的潜力。该研究招募了251名成年参与者，评估了黑棘皮病的存在，并通过生化和物理测量方法评估肝脏健康状况。结果表明，黑棘皮病与较高的肝脂肪变程度之间存在显著关联，特别是在超重和肥胖个体中。本研究表明，在资源有限的临床环境中使用黑棘皮病作为MASLD筛查工具具有成本效益，尽管推荐进行进一步研究以探索其他诊断方法。这项研究的重要之处在于它评估了黑棘皮病（AN）作为代谢功能障碍相关性肝脂肪变性疾病（MASLD）的临床预测指标的角色，后者与肥胖症和胰岛素抵抗有关的一种常见病症。理解黑棘皮病与MASLD之间的关联可以提高早期检测和干预策略的有效性，特别是在先进诊断工具不可用的情况下资源有限的医疗环境中。该研究的结果突显了使用黑棘皮病作为简单的非侵入性筛查工具来识别患有MASLD高危个体的潜在价值，这可能导致及时管理并改善健康结果。这项研究表明需要进一步的研究开发适用于具有特定临床或人口统计学特征人群（例如拉丁美洲人）的替代诊断方法。
