Liver disease is fast emerging as a global health priority. Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in Western countries, with an increasing prevalence associated with the rising prevalence of diabetes mellitus and obesity. The worldwide prevalence of NAFLD may be in the order of 25%, but in the Middle East, it may be even higher. This study aimed to estimate the prevalence of NAFLD in the Kingdom of Saudi Arabia (KSA). A systematic review and meta-analysis were undertaken. Electronic searches were carried out through Medline, EMBASE, CINAHL, Web of Science, and Google Scholar, for articles from inception to April 2020. Studies conducted on adult populations in any setting reporting NAFLD prevalence were included. Pooled proportions and associated 95% confidence intervals (CIs) were presented in forest plots using a random effect model. Eight studies, including 4045 participants, were included. The pooled prevalence of NAFLD among all adult populations in KSA was 16.8% (11.1%-22.5%). Amongst those with type 2 diabetes, the prevalence was 58.0% (45.0%-70.9%). There were no true general population studies of the prevalence of NAFLD in KSA available. This review suggests that NAFLD is common in the KSA, and that type 2 diabetes is a risk factor in KSA as identified elsewhere in the world.

The anticancer activity of sulforaphane (SFN) involves multiple signaling pathways, but its mechanism against Ehrlich Ascites Carcinoma (EAC) in mice remains unclear. This study evaluated the antitumor efficacy of SFN-loaded nanoliposomes (SFN-NLPs). Ninety female Swiss albino mice were allocated into six groups: (1) untreated control, (2) SFN alone (50 mg/kg/day, orally), (3) SFN-NLPs alone (50 mg/kg/day, orally), (4) EAC-bearing mice (2.5 × 10⁶ cells, intraperitoneally), (5) EAC + SFN, and (6) EAC + SFN-NLPs. with treatment lasting 20 days in tumor-bearing groups. SFN-NLPs significantly reduced EAC tumor volume, viable cell count, and tumor marker levels, while prolonging survival more effectively than free SFN. SFN-NLPs modulated key molecular pathways by suppressing inflammatory gene expression ( NF-κB , COX-2 ) and shifting the balance toward apoptosis via upregulation of TP53 and Bax and concomitant downregulation of Bcl-2 . Regarding liver integrity, SFN-NLPs significantly reduced DNA fragmentation and hepatic oxidative stress, while modulating systemic inflammation through reductions in total leukocyte count, TNF-α, and C-reactive protein. In addition, SFN-NLPs conferred superior protection against both histopathological and ultrastructural liver damage. Furthermore, molecular docking analysis suggested plausible interactions of SFN with proteins associated with antioxidant defense, inflammation regulation, and apoptosis, indicating a potential modulatory role. In conclusion, nanoformulated SFN enhances stability, augments efficacy, and facilitates sustained release and bioavailability, thereby strengthening its antitumor, anti-inflammatory, antioxidant, and pro-apoptotic effects in EAC-bearing mice. These findings highlight the potential of SFN-NLPs to suppress tumor growth by modulating inflammatory and apoptotic gene expression while preserving liver integrity.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly common and poses a growing challenge for health systems, because most affected people are managed outside specialist liver services. The clinically important task is not simply to identify hepatic steatosis, but to find the smaller subgroup with clinically significant fibrosis who face the greatest risk of liver-related complications and who may now be eligible for liver-directed pharmacotherapy. The fibrosis-4 index (FIB-4), calculated from age, aspartate aminotransferase, alanine aminotransferase and platelet count, has emerged as a pragmatic first-line tool for fibrosis risk stratification. Contemporary guidance recommends a stepwise approach in at-risk populations, with FIB-4 followed by second-line non-invasive testing, most commonly vibration-controlled transient elastography (VCTE) or the Enhanced Liver Fibrosis (ELF) test. The September 2026 Global NASH/MASH Council consensus consolidates this fibrosis-centred, non-invasive-test-driven model further and links second-line test thresholds to treatment initiation and response monitoring in non-cirrhotic MASH with F2–F3 fibrosis. Saudi Arabia is a particularly relevant setting given its substantial cardiometabolic burden and emerging evidence of a high MASLD prevalence. Recent Saudi data include a multicentre primary-care cohort reporting an age- and sex-adjusted MASLD prevalence of 34.2%, a real-world primary-care study demonstrating intermediate or high FIB-4 risk among metabolically high-risk patients despite normal liver enzymes, and a Saudi consensus incorporating FIB-4 into local risk stratification. Important implementation questions remain, however, including target populations, age-related interpretation, laboratory readiness, second-line testing capacity, referral pathways, treatment access, repeat assessment, electronic health-record integration and cost-effectiveness. This narrative review traces the evolution of FIB-4 from a prognostic marker to a primary-care triage tool, critically examines contemporary international and Saudi evidence, and proposes a context-sensitive framework and staged research agenda for FIB-4-based risk stratification in Saudi primary care.

Background/Objectives: Nonalcoholic fatty liver disease (NAFLD), also referred to as metabolic dysfunction-associated steatotic liver disease (MASLD), affects roughly one-quarter of the global population and represents a major public health concern. Despite its rising prevalence and potential for serious complications, NAFLD remains underrecognized and poorly understood in many communities. This study aimed to assess knowledge of NAFLD and its determinants among adults in the Northern Border Region of Saudi Arabia. Methods: A descriptive, population-based cross-sectional study was conducted using a previously validated online questionnaire adapted from published NAFLD awareness instruments, administered to adults residing in the Northern Border Region of Saudi Arabia. Data were analyzed using Python (statsmodels, version 0.14), and non-parametric tests, correlation analyses, and multivariable linear regression were used to examine NAFLD knowledge and its associated determinants. Results: A total of 1016 adults (mean age 34.7 ± 11.8 years) were included in the analysis. The mean NAFLD knowledge score was 14.6 ± 8.3 out of 30 (48.7% correct responses), with a median of 16 (interquartile range 8–21). Overall, 59.2% of participants had poor knowledge, 26.8% had moderate knowledge, and 14% had good knowledge. In bivariate analyses, educational level (χ² = 15.62, p < 0.001), family history of liver disease (p = 0.001), body weight category (p = 0.003), and smoking status (p = 0.007) were significantly associated with NAFLD knowledge. In multivariable linear regression, university education (B = 2.783, 95% CI 0.627–4.940, p = 0.011) was an independent positive predictor of higher knowledge scores. Current smoking (B = −1.857, 95% CI −3.477 to −0.237, p = 0.025), private-sector employment (B = −1.934, 95% CI −3.867 to −0.001, p = 0.050), and overweight status (B = −4.119, 95% CI −7.337 to −0.901, p = 0.012) were independently associated with lower knowledge scores. The final model explained 2.2% of the variance in knowledge (adjusted R² = 0.022). Conclusions: This study demonstrates generally low levels of NAFLD knowledge among adults in the Northern Border Region of Saudi Arabia, with only a minority achieving good knowledge scores. The findings underscore the need for targeted health promotion initiatives, educational interventions, and public campaigns to improve awareness of NAFLD and to support its prevention and management.

Background/Objectives: Chronic non-malignant pain (CNMP) affects 46.4% of adults in Saudi Arabia and often requires interdisciplinary care, including mental health services. Despite this need, mental health integration remains limited. This study explored healthcare providers’ perceptions of integrating mental health services into CNMP management and identified barriers and facilitators to interdisciplinary collaboration. Methods: A cross-sectional survey was conducted among 114 healthcare providers across Saudi Arabia. Using the Theoretical Domains Framework (TDF), domains such as knowledge, skills, beliefs about capabilities and consequences, reinforcement, and social influences were assessed. Data were analyzed using descriptive statistics, correlation analyses, and multiple regression. Results: Positive perceptions of mental health integration were significantly associated with beliefs about capabilities (r = 0.31, p = 0.001) and beliefs about consequences (r = 0.40, p < 0.001), as well as skills (r = 0.30, p = 0.001) and reinforcement (r = 0.26, p = 0.005). Multiple regression confirmed beliefs about capabilities (B = 0.208, p = 0.001) and consequences (B = 0.237, p < 0.001) as independent predictors, explaining 31.9% of the variance in perceptions (R² = 0.319, adjusted R² = 0.285). Emotional responses, such as stress, were potential barriers but did not independently predict perceptions. Systemic challenges included limited referral pathways and insufficient mental health resources. Conclusion: Confidence in professional abilities and recognition of the benefits of collaboration are key drivers of positive perceptions toward mental health integration in CNMP care. Interventions that enhance provider confidence, emphasize interdisciplinary benefits, and strengthen organizational support may improve engagement with mental healthcare services in Saudi Arabia.