Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://gr.elmerpub.com

Original Article

Volume 19, Number 3, June 2026, pages 147-154

Glucagon-Like Peptide-1 Receptor Agonist Therapy Reduces Fibrosis-4 Index in Metabolic Dysfunction-Associated Steatotic Liver Disease

↓ **Table 1.** Baseline Patient Characteristics
BMI: body mass index; GLP-1 RA: glucagon-like peptide-1 receptor agonist; IQR: interquartile range.
Total (n)	29
Sex (n, %)
Female	17 (58.6%)
Male	12 (41.4%)
Age (mean, median, IQR, range)	62.0, 60.9, 56.6–67.6, 40.8–79.3
BMI (mean, median, IQR, range)	37.5, 35.7, 32.0–41.7, 26.5–53.7
GLP-1 RA (n, %)
Semaglutide	17 (58.6%)
Dulaglutide	8 (27.6%)
Liraglutide	2 (6.9%)
Tirzepatide	2 (6.9%)
GLP-1 RA indication (n, %)
Type 2 diabetes	18 (62.1%)
Obesity	11 (37.9%)

↓ Table 1. Baseline Patient Characteristics

BMI: body mass index; GLP-1 RA: glucagon-like peptide-1 receptor agonist; IQR: interquartile range.

Total (n)

Sex (n, %)

Female

17 (58.6%)

Male

12 (41.4%)

Age (mean, median, IQR, range)

62.0, 60.9, 56.6–67.6, 40.8–79.3

BMI (mean, median, IQR, range)

37.5, 35.7, 32.0–41.7, 26.5–53.7

GLP-1 RA (n, %)

Semaglutide

17 (58.6%)

Dulaglutide

8 (27.6%)

Liraglutide

2 (6.9%)

Tirzepatide

2 (6.9%)

GLP-1 RA indication (n, %)

Type 2 diabetes

18 (62.1%)

Obesity

11 (37.9%)

↓ **Table 2.** Mean Values of Primary and Secondary Outcomes at Baseline and After 12 Months of GLP-1 RA Therapy
	Baseline (SD)	Post-GLP-1 RA (SD)	Difference (95% CI)	P-value
A1c: hemoglobin A1c; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BMI: body mass index; CI: confidence interval; FIB-4: fibrosis-4; GLP-1 RA: glucagon-like peptide-1 receptor agonist; SD: standard deviation.
FIB-4	1.94 (0.61)	1.73 (0.62)	-0.21 (-0.38, -0.05)	0.019
AST (U/L)	48.9 (22.4)	33.1 (17.4)	-15.8 (-22.3, -9.3)	< 0.001
ALT (U/L)	60.3 (34.3)	38.4 (27.0)	-21.9 (-30.8, -13.0)	< 0.001
Platelets (× 10³/µL)	212.2 (51.1)	215.3 (57.6)	3.1 (-4.9, 11.1)	0.742
BMI (kg/m²)	37.5 (7.0)	34.9 (6.8)	-2.6 (-3.7, -1.5)	< 0.001
A1c (%)	7.4 (1.8)	6.3 (1.0)	-1.1 (-1.5, -0.6)	< 0.001

↓ Table 2. Mean Values of Primary and Secondary Outcomes at Baseline and After 12 Months of GLP-1 RA Therapy

Baseline (SD)

Post-GLP-1 RA (SD)

Difference (95% CI)

P-value

A1c: hemoglobin A1c; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BMI: body mass index; CI: confidence interval; FIB-4: fibrosis-4; GLP-1 RA: glucagon-like peptide-1 receptor agonist; SD: standard deviation.

FIB-4

1.94 (0.61)

1.73 (0.62)

-0.21 (-0.38, -0.05)

0.019

AST (U/L)

48.9 (22.4)

33.1 (17.4)

-15.8 (-22.3, -9.3)

< 0.001

ALT (U/L)

60.3 (34.3)

38.4 (27.0)

-21.9 (-30.8, -13.0)

< 0.001

Platelets (× 10³/µL)

212.2 (51.1)

215.3 (57.6)

3.1 (-4.9, 11.1)

0.742

BMI (kg/m²)

37.5 (7.0)

34.9 (6.8)

-2.6 (-3.7, -1.5)

< 0.001

A1c (%)

7.4 (1.8)

6.3 (1.0)

-1.1 (-1.5, -0.6)

< 0.001

↓ **Table 3.** Change in FIB-4 Index (ΔFIB-4), BMI (ΔBMI), Hemoglobin A1c (ΔA1c), AST (ΔAST), and ALT (ΔALT) Stratified by GLP-1 RA Agent Over 12 Months
GLP-1 agent	n	Baseline FIB-4, mean (SD)	ΔFIB-4, mean (SD)	ΔBMI (kg/m²), mean (SD)	ΔA1c (%), mean (SD)	ΔAST (U/L), mean (SD)	ΔALT (U/L), mean (SD)
Values are presented as mean (standard deviation). All delta values represent post-treatment minus baseline. ^an = 27 for ΔA1c (two patients with missing post-treatment A1c values excluded from that column only). ^bSD not calculable for liraglutide ΔA1c; only one patient had complete A1c data. ALT: alanine aminotransferase; AST: aspartate aminotransferase; BMI: body mass index; FIB-4: fibrosis-4; GLP-1 RA: glucagon-like peptide-1 receptor agonist; SD: standard deviation.
Semaglutide	17	1.84 (0.69)	−0.19 (0.55)	−2.72 (4.24)	−1.44 (1.48)	−16.2 (16.4)	−23.6 (26.9)
Dulaglutide	8	1.94 (0.51)	−0.36 (0.40)	−2.27 (2.01)	−0.59 (0.79)	−20.1 (20.7)	−26.8 (31.8)
Liraglutide	2	2.34 (0.04)	+0.38 (0.85)	−0.34 (3.04)	+0.50 (—)^b	+14.5 (43.1)	+6.5 (38.9)
Tirzepatide	2	2.35 (0.52)	−0.38 (0.03)	−5.15 (2.11)	−0.60 (1.13)	−25.5 (26.2)	−17.0 (15.6)
Overall	29^a	1.94 (0.61)	−0.21 (0.52)	−2.60 (3.56)	−1.05 (1.32)	−15.8 (21.3)	−21.9 (29.3)

↓ Table 3. Change in FIB-4 Index (ΔFIB-4), BMI (ΔBMI), Hemoglobin A1c (ΔA1c), AST (ΔAST), and ALT (ΔALT) Stratified by GLP-1 RA Agent Over 12 Months

GLP-1 agent

Baseline FIB-4, mean (SD)

ΔFIB-4, mean (SD)

ΔBMI (kg/m²), mean (SD)

ΔA1c (%), mean (SD)

ΔAST (U/L), mean (SD)

ΔALT (U/L), mean (SD)

Values are presented as mean (standard deviation). All delta values represent post-treatment minus baseline. ^an = 27 for ΔA1c (two patients with missing post-treatment A1c values excluded from that column only). ^bSD not calculable for liraglutide ΔA1c; only one patient had complete A1c data. ALT: alanine aminotransferase; AST: aspartate aminotransferase; BMI: body mass index; FIB-4: fibrosis-4; GLP-1 RA: glucagon-like peptide-1 receptor agonist; SD: standard deviation.

Semaglutide

1.84 (0.69)

−0.19 (0.55)

−2.72 (4.24)

−1.44 (1.48)

−16.2 (16.4)

−23.6 (26.9)

Dulaglutide

1.94 (0.51)

−0.36 (0.40)

−2.27 (2.01)

−0.59 (0.79)

−20.1 (20.7)

−26.8 (31.8)

Liraglutide

2.34 (0.04)

+0.38 (0.85)

−0.34 (3.04)

+0.50 (—)^b

+14.5 (43.1)

+6.5 (38.9)

Tirzepatide

2.35 (0.52)

−0.38 (0.03)

−5.15 (2.11)

−0.60 (1.13)

−25.5 (26.2)

−17.0 (15.6)

Overall

29^a

1.94 (0.61)

−0.21 (0.52)

−2.60 (3.56)

−1.05 (1.32)

−15.8 (21.3)

−21.9 (29.3)

↓ **Table 4.** Multivariable Linear Regression: Independent Predictors of Change in FIB-4 Index (ΔFIB-4) Over 12 Months of GLP-1 RA Therapy (n = 27)
Variable	β	SE	95% CI	t	P-value	Std β
Reference category for GLP-1 agent type: semaglutide. *P < 0.05. Full model: R² = 0.891, Adjusted R² = 0.798. Reduced model (ΔBMI, ΔA1c, baseline FIB-4, age, sex, DM; n = 27): R² = 0.617, Adjusted R² = 0.502, F(6,20) = 5.37, P = 0.002. ALT: alanine aminotransferase; AST: aspartate aminotransferase; BMI: body mass index; CI: confidence interval; FIB-4: fibrosis-4; GLP-1 RA: glucagon-like peptide-1 receptor agonist; SE: standard error; Std β: standardized beta coefficient (continuous predictors scaled to SD = 1).
Intercept	−0.327	0.603	−1.621 to 0.966	−0.543	0.596	—
ΔBMI (kg/m²)	0.020	0.017	−0.015 to 0.056	1.219	0.243	0.074
ΔAST (U/L)	0.005	0.007	−0.011 to 0.021	0.662	0.519	0.104
ΔALT (U/L)	0.001	0.005	−0.009 to 0.010	0.182	0.858	0.024
ΔA1c (%)	−0.167	0.074	−0.324 to −0.009	−2.271	0.040*	−0.220
Baseline FIB-4	−0.538	0.121	−0.797 to −0.278	−4.446	< 0.001*	−0.334
Age (years)	0.024	0.011	0.001 to 0.046	2.243	0.042*	0.212
Male sex	0.519	0.138	0.222 to 0.816	3.749	0.002*	0.260
Diabetes mellitus	−0.649	0.223	−1.128 to −0.170	−2.906	0.012*	−0.312
GLP-1 duration (days)	−0.001	0.001	−0.002 to 0.001	−1.145	0.271	−0.083
Tirzepatide vs. semaglutide	0.870	0.291	0.245 to 1.494	2.987	0.010*	0.232
Liraglutide vs. semaglutide	1.250	0.489	0.202 to 2.298	2.559	0.023*	0.241
Dulaglutide vs. semaglutide	0.177	0.168	−0.184 to 0.538	1.052	0.311	0.082

↓ Table 4. Multivariable Linear Regression: Independent Predictors of Change in FIB-4 Index (ΔFIB-4) Over 12 Months of GLP-1 RA Therapy (n = 27)

Variable

95% CI

P-value

Std β

Reference category for GLP-1 agent type: semaglutide. *P < 0.05. Full model: R² = 0.891, Adjusted R² = 0.798. Reduced model (ΔBMI, ΔA1c, baseline FIB-4, age, sex, DM; n = 27): R² = 0.617, Adjusted R² = 0.502, F(6,20) = 5.37, P = 0.002. ALT: alanine aminotransferase; AST: aspartate aminotransferase; BMI: body mass index; CI: confidence interval; FIB-4: fibrosis-4; GLP-1 RA: glucagon-like peptide-1 receptor agonist; SE: standard error; Std β: standardized beta coefficient (continuous predictors scaled to SD = 1).

Intercept

−0.327

0.603

−1.621 to 0.966

−0.543

0.596

—

ΔBMI (kg/m²)

0.020

0.017

−0.015 to 0.056

1.219

0.243

0.074

ΔAST (U/L)

0.005

0.007

−0.011 to 0.021

0.662

0.519

0.104

ΔALT (U/L)

0.001

0.005

−0.009 to 0.010

0.182

0.858

0.024

ΔA1c (%)

−0.167

0.074

−0.324 to −0.009

−2.271

0.040*

−0.220

Baseline FIB-4

−0.538

0.121

−0.797 to −0.278

−4.446

< 0.001*

−0.334

Age (years)

0.024

0.011

0.001 to 0.046

2.243

0.042*

0.212

Male sex

0.519

0.138

0.222 to 0.816

3.749

0.002*

0.260

Diabetes mellitus

−0.649

0.223

−1.128 to −0.170

−2.906

0.012*

−0.312

GLP-1 duration (days)

−0.001

0.001

−0.002 to 0.001

−1.145

0.271

−0.083

Tirzepatide vs. semaglutide

0.870

0.291

0.245 to 1.494

2.987

0.010*

0.232

Liraglutide vs. semaglutide

1.250

0.489

0.202 to 2.298

2.559

0.023*

0.241

Dulaglutide vs. semaglutide

0.177

0.168

−0.184 to 0.538

1.052

0.311

0.082