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Adipose Tissue_Appetite_and Obesity

SAT-694 - Association Between Circulating Inflammatory Biomarkers (CRP, IL-6, TNF-α) and Progression to MASH in Patients with Obesity: A Systematic Review

Saturday, June 13, 2026
9:30 AM - 4:30 PM CT


Introduction: Obesity is one of the most prevalent chronic diseases and represents a major public health concern. Concurrently, metabolic dysfunction–associated steatotic liver disease (MASLD) has become one of the most common liver conditions, affecting 70–80% of individuals with obesity. Adipose tissue releases pro-inflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), which contribute to hepatocellular injury and sustain inflammation. IL-6 also stimulates hepatic production of C-reactive protein (CRP), an acute-phase marker widely used to assess systemic inflammation. In this context, circulating inflammatory biomarkers have been investigated as indicators of progression to metabolic dysfunction–associated steatohepatitis (MASH).

Objective: This study aimed to analyze the association between elevated levels of inflammatory biomarkers (CRP, IL-6, TNF-α) and the risk of progression to MASH or increased severity of hepatic fibrosis in patients with obesity.

Methods: A systematic review was conducted following PRISMA guidelines. The population included individuals with body mass index (BMI) ≥ 40, at risk of MASLD and MASH. A comprehensive search was performed in PubMed, Cochrane Library, and Embase for studies published between 2010 and 2026. Eligible studies evaluated the association between elevated inflammatory biomarkers and progression to MASH or fibrosis severity.

Results: Nineteen studies, totaling approximately 3,900 participants, were included. Results were heterogeneous but generally convergent. About 63% of the studies (≈12/19) showed that elevated CRP, IL-6, and TNF-α levels were significantly associated with MASH and/or greater fibrosis severity, while 21% (≈4/19) found no significant association. CRP was associated with hepatic steatosis and systemic inflammation, although its predictive value for MASH was inconsistent. However, high-sensitivity CRP (hs-CRP) ≥ 4.35 mg/L showed potential in identifying hepatic inflammation in some studies. IL-6 and TNF-α were more consistently elevated in patients with MASH compared to those with simple steatosis.

Conclusion: circulating inflammatory biomarkers are associated with the progression from MASLD to MASH and with increased fibrosis severity. However, their isolated use has limitations, highlighting the multifactorial nature of the disease and the need for combined approaches to improve prediction

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