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Identifying advanced MAFLD in a cohort of T2DM and clinical features
Ana Maria Sanchez-Bao1, Alfonso Soto-Gonzalez2, Manuel Delgado-Blanco3
1Division of Endocrinology and Nutrition, Ferrol University Clinical Hospital, Ferrol, Spain.
Background:
MAFLD is the most common cause of chronic liver disease, affecting 25% of the global population. Patients with T2DM have an increased risk of developing MAFLD. In addition, patients with T2DM have a higher risk of advanced forms of steatohepatitis and fibrosis. Identifying those patients is critical in order to refer them to specialist and appropriate management of their disease.
Aims And Objectives:
To estimate advanced fibrosis prevalence in a cohort of patients with T2DM and to identify possible predictors.
Methods:
subjects with T2DM during regular health check-up were enrolled. Demographic and general characteristics were measured, including metabolic parameters and homeostasis model assessment of insulin resistance (HOMA2-IR). Four non-invasive fibrosis scores (NAFLD fibrosis scores, FIB-4, APRI, Hepamet fibrosis score) were measure and compared with transient elastography (TE).
Results:
96 patients (21%) presented risk of significant fibrosis (≥F2) measured by TE and 45 patients (10%) presented with risk of advanced fibrosis F3-F4. Liver fibrosis was related to BMI, AC, HOMA2-IR. The results of the non-invasive fibrosis scores have been validated with the results obtained in the TE. It is observed that the index with the greatest area under the curve (AUC) is APRI (AUC=0.729), with a sensitivity of 62.2% and a specificity of 76.1%. However, the test with better positive likelihood ratio (LR+) in our study is NAFLD fibrosis score.
Conclusions:
Our results show that in a general T2DM follow up, 10% of patients were at risk of advanced fibrosis. We found a positive correlation between liver fibrosis and BMI, AC and HOMA2-IR. Non-invasive fibrosis markers can be useful for screening, showing NAFLD Fibrosis score a better LHR+ compared to TE. Further studies are needed to validate these results and elucidate the best screening approach to identify those patients at risk of advanced MAFLD.
Insights
In patients with type 2 diabetes (T2DM), 10% risk advanced liver fibrosis. Non-invasive markers like NAFLD fibrosis score aid screening for MAFLD in T2DM patients.
Area of Science:
- Hepatology
- Endocrinology
- Metabolic Syndrome
Background:
- Metabolic-associated fatty liver disease (MAFLD) is the leading cause of chronic liver disease globally, impacting 25% of the population.
- Patients with type 2 diabetes mellitus (T2DM) face a heightened risk of developing MAFLD, including advanced stages like steatohepatitis and fibrosis.
- Early identification of T2DM patients with MAFLD is crucial for timely specialist referral and disease management.
Purpose of the Study:
- To determine the prevalence of advanced liver fibrosis in a cohort of T2DM patients.
- To identify potential predictors of advanced fibrosis in this population.
Main Methods:
- A cohort of T2DM patients undergoing regular health check-ups were enrolled.
- Demographic, metabolic parameters, and HOMA2-IR were assessed.
- Four non-invasive fibrosis scores (NAFLD fibrosis score, FIB-4, APRI, Hepamet) were compared against transient elastography (TE).
Main Results:
- 21% of patients showed risk of significant fibrosis (≥F2) by TE, with 10% at risk of advanced fibrosis (F3-F4).
- Liver fibrosis correlated positively with BMI, waist circumference (AC), and HOMA2-IR.
- APRI demonstrated the highest AUC (0.729), while the NAFLD fibrosis score showed the best positive likelihood ratio (LR+).
Conclusions:
- Approximately 10% of T2DM patients in general follow-up are at risk for advanced liver fibrosis.
- Non-invasive fibrosis markers are valuable screening tools, with the NAFLD fibrosis score showing superior LR+ compared to TE.
- Further research is needed to validate these findings and optimize screening strategies for advanced MAFLD in T2DM patients.
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