Significant Impact of Polypharmacy on Metabolic Dysfunction–Associated Steatotic Liver Disease: Experience from Family Medicine Practice

1.1 Background Steatotic liver disease (SLD) has emerged as a major public health problem due to its rapidly increasing prevalence and associated disease burden. Metabolic dysfunction–associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), represents a newly adopted nomenclature. In some regions, the term metabolic associated fatty liver disease (MAFLD) is also used, based on slightly different diagnostic criteria. This study aimed to determine the prevalence of NAFLD, MAFLD, and MASLD among adult patients presenting to family medicine outpatient clinics and to evaluate the association of MASLD and polypharmacy. 1.2 Methods In this cross-sectional study, a total of 1,159 patients who presented to our tertiary care outpatient clinic between 2023 and 2024 were initially screened. After applying the predefined inclusion and exclusion criteria, 408 patients were ultimately included in the final analysis. NAFLD, MAFLD and MASLD were diagnosed according to diagnostic criteria defined by guidelines. Polypharmacy was defined as the concurrent use of more than 5 medications. 1.3 Results Among the 408 participants, 51.7% met the criteria for NAFLD (N = 211), 52.2% for MAFLD (N = 213), and 50.5% for MASLD (N = 206). Patients with SLD were older and had significantly higher prevalences of hypertension, diabetes mellitus, dyslipidemia, and polypharmacy (P < 0.005 for each). In univariable analyses, NAFLD, MAFLD, and MASLD were all associated with increased odds of polypharmacy, with MAFLD showing the strongest association (OR: 2.34; 95% CI: 1.30–4.24). After adjustment for age and sex, only MAFLD remained significantly associated with polypharmacy (OR: 1.63; 95% CI: 1.01–2.65). This association persisted after further adjustment for cardiometabolic risk factors (OR: 1.58; 95% CI: 1.02–2.46), whereas NAFLD and MASLD were no longer significant. The combined presence of NAFLD, MAFLD, and MASLD was associated with polypharmacy in univariable analysis (OR: 2.19; 95% CI: 1.21–3.96) but not after full adjustment. 1.4 Conclusion The prevalence of NAFLD, MAFLD, and MASLD was significantly high and these conditions were significantly associated with advanced age, metabolic comorbidities, and polypharmacy. Future multicenter, prospective studies are needed to further elucidate the impact of polypharmacy on disease severity. 1.5 Trial registration Not applicable.