Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. However, in routine outpatient practice, it is often diagnosed late. This is especially true in southern Russia, a region with high metabolic syndrome prevalence. No multicenter studies of NAFLD in this region have been conducted before. This study analyzed outpatient records of NAFLD patients in Stavropol, Rostov-on-Don, Krasnodar, and Astrakhan. We aimed to identify clinical and laboratory patterns, assess timely diagnosis, and explore interregional differences. We conducted a retrospective study of 480 outpatient records from patients with verified NAFLD (2024–2025). Anthropometric, laboratory, and instrumental data were collected. Fibrosis and insulin resistance indices were calculated. Abdominal obesity was present in 82.1% of patients. Arterial hypertension was found in 75.8%. Dyslipidemia occurred in 74.6%. Type 2 diabetes was diagnosed in 47.1%. Insulin resistance was recorded in 82.3%. The diagnosis of NAFLD was first established during this study in 38.8% of patients. Among these, 72% had normal alanine aminotransferase levels. High fibrosis risk was identified in 9.2% of patients. Stable interregional differences were observed. Krasnodar had the most severe metabolic profile and the highest fibrosis risk. Stavropol had the lowest. In conclusion, NAFLD in southern Russia shows high rates of metabolic disorders and late diagnosis. Relying only on transaminase levels is insufficient. Active screening using anthropometry and ultrasound is necessary for all patients with metabolic syndrome components.
