Does Fetuin-A, RAGE, FGF-23 levels associated with cardiovascular risk or fibrosis score in patients with metabolic dysfunction-associated steatotic liver disease?

Zeynep Ozan; Ayşe Yeşim Göçmen; Mehmet Çelikbilek; Tekin Yıldırım

Does Fetuin-A, RAGE, FGF-23 levels associated with cardiovascular risk or fibrosis score in patients with metabolic dysfunction-associated steatotic liver disease?

Abstract

Aims: Increasing evidence suggests that cardiovascular disease risk increases in metabolic dysfunction-associated steatotic liver disease (MASLD). Fetuin-A, reseptor for advanced glycation end-products (RAGE) and fibroblast growth factor 23 (FGF-23) are associated with insulin resistance (IR), inflammation, oxidative stress, and so predispose to coronary heart disease (CHD). We aimed to investigate the clinical utility of Fetuin-A, RAGE and FGF-23 in assessing CHD risk evaluated by Framingham risk score (FRS) in patients with MASLD. Methods: The study included 80 individuals aged 34-82 years who met the diagnostic criteria for MASLD, and a control group of 60 individuals with normal liver echogenicity on ultrasonography and FRS values less than 10% in cardiac risk assessment. Patients in the MASLD group were further divided into two subgroups: low cardiac risk (FRS <10%) and moderate/high cardiac risk (FRS ≥10%). In addition to routine tests, HOMA-IR, Fetuin-A, RAGE, and FGF-23 levels were also measured. Risk scoring systems related to the prognosis of fatty liver disease, including the AST/platelet ratio index (APRI); fibrosis score (FIB4); fatty liver fibrosis score (NFS); and fatty liver index (FLI), were also calculated. Results: In MASLD patients, anthropometric measurements such as BMI, WC, SBP and DBP; and hematocrit, WBC, AST, ALT, GGT, AP, total cholesterol, TG, LDL-C, fasting insulin, glucose, RAGE, and FGF-23 levels were significantly higher; while HDL-C, albumin, and Fetuin-A levels were lower. Any significance was between the groups in terms of mean age, gender, platelet count, total bilirubin, and direct bilirubin levels. FRS and HOMA-IR levels were also significantly higher in the MASLD group (p<0.001). In MASLD patients with moderate/high probability cardiovascular risk; BMI, PLT, hematocrit, AST, ALT, ALP, GGT, TG, LDL-C, FGF-23, RAGE, FIB-4, and FLI levels tended to be higher; albumin, PLT, and Fetuin-A levels were lower (P<0.05). Any increase in CHD severity was detected with respect to fatty liver severity. Conclusion: In the MASLD group, as cardiac risk increased, RAGE and FGF-23 levels rose significantly, while Fetuin A levels decreased. Any association was found between APRI and NFS scores and cardiac risk; however, FLI and FIB-4 scores were associated with cardiac risk. In particular, higher FGF-23 levels were found to be associated with more parameters. Therefore, non-invasive fibrosis markers, especially FLI and FIB-4 scores, can be used clinically in the follow-up of fatty liver disease patients. FGF-23 levels, on the other hand, can guide clinicians in determining both the severity of renal failure and heart disease.

Keywords

Supporting Institution

This work was supported by grants from Bozok University BAP unit with a number 2015TF/A205.

Ethical Statement

Ethics approval has been obtained from the Clinical Research Ethics Committee of Yozgat Bozok University.

Thanks

We thank Dr. Ahmet Aktas and Dr. Ilyas Pirti for their assistance.

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Details

Primary Language

English

Subjects

Cardiovascular Medicine and Haematology (Other), Gastroenterology and Hepatology

Journal Section

Research Article

Authors

Zeynep Ozan ^*
0000-0002-4654-8982
Türkiye

Ayşe Yeşim Göçmen
0000-0002-8511-639X
Türkiye

Mehmet Çelikbilek
0000-0001-8890-3885
Türkiye

Tekin Yıldırım
0000-0002-8442-4788
Türkiye

Publication Date

May 22, 2026

Submission Date

December 16, 2025

Acceptance Date

March 15, 2026

Published in Issue

Year 2026 Volume: 8 Number: 3

IZ

https://izlik.org/JA52WW95TP

Cite

RIS / Bibtex

APA

Ozan, Z., Göçmen, A. Y., Çelikbilek, M., & Yıldırım, T. (2026). Does Fetuin-A, RAGE, FGF-23 levels associated with cardiovascular risk or fibrosis score in patients with metabolic dysfunction-associated steatotic liver disease? Anatolian Current Medical Journal, 8(3), 378-384. https://izlik.org/JA52WW95TP

AMA

1.Ozan Z, Göçmen AY, Çelikbilek M, Yıldırım T. Does Fetuin-A, RAGE, FGF-23 levels associated with cardiovascular risk or fibrosis score in patients with metabolic dysfunction-associated steatotic liver disease? Anatolian Curr Med J / ACMJ / acmj. 2026;8(3):378-384. https://izlik.org/JA52WW95TP

Chicago

Ozan, Zeynep, Ayşe Yeşim Göçmen, Mehmet Çelikbilek, and Tekin Yıldırım. 2026. “Does Fetuin-A, RAGE, FGF-23 Levels Associated With Cardiovascular Risk or Fibrosis Score in Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease?”. Anatolian Current Medical Journal 8 (3): 378-84. https://izlik.org/JA52WW95TP.

EndNote

Ozan Z, Göçmen AY, Çelikbilek M, Yıldırım T (May 1, 2026) Does Fetuin-A, RAGE, FGF-23 levels associated with cardiovascular risk or fibrosis score in patients with metabolic dysfunction-associated steatotic liver disease? Anatolian Current Medical Journal 8 3 378–384.

IEEE

[1]Z. Ozan, A. Y. Göçmen, M. Çelikbilek, and T. Yıldırım, “Does Fetuin-A, RAGE, FGF-23 levels associated with cardiovascular risk or fibrosis score in patients with metabolic dysfunction-associated steatotic liver disease?”, Anatolian Curr Med J / ACMJ / acmj, vol. 8, no. 3, pp. 378–384, May 2026, [Online]. Available: https://izlik.org/JA52WW95TP

ISNAD

Ozan, Zeynep - Göçmen, Ayşe Yeşim - Çelikbilek, Mehmet - Yıldırım, Tekin. “Does Fetuin-A, RAGE, FGF-23 Levels Associated With Cardiovascular Risk or Fibrosis Score in Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease?”. Anatolian Current Medical Journal 8/3 (May 1, 2026): 378-384. https://izlik.org/JA52WW95TP.

JAMA

1.Ozan Z, Göçmen AY, Çelikbilek M, Yıldırım T. Does Fetuin-A, RAGE, FGF-23 levels associated with cardiovascular risk or fibrosis score in patients with metabolic dysfunction-associated steatotic liver disease? Anatolian Curr Med J / ACMJ / acmj. 2026;8:378–384.

MLA

Ozan, Zeynep, et al. “Does Fetuin-A, RAGE, FGF-23 Levels Associated With Cardiovascular Risk or Fibrosis Score in Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease?”. Anatolian Current Medical Journal, vol. 8, no. 3, May 2026, pp. 378-84, https://izlik.org/JA52WW95TP.

Vancouver

1.Zeynep Ozan, Ayşe Yeşim Göçmen, Mehmet Çelikbilek, Tekin Yıldırım. Does Fetuin-A, RAGE, FGF-23 levels associated with cardiovascular risk or fibrosis score in patients with metabolic dysfunction-associated steatotic liver disease? Anatolian Curr Med J / ACMJ / acmj [Internet]. 2026 May 1;8(3):378-84. Available from: https://izlik.org/JA52WW95TP