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Low Rates of MASLD Screening in Young Adults With Type 2 Diabetes: A Retrospective Cohort Study
Chloe A de Crecy1, Qiang Yang2, Mei Liu2
1Division of Endocrinology, Diabetes and Metabolism, University of Florida College of Medicine, Gainesville, FL 32610, USA.
Context:
Regardless of age, metabolic dysfunction-associated steatotic liver disease (MASLD) occurs in 70% of adults with type 2 diabetes (T2D) and increases the risk of metabolic dysfunction-associated steatohepatitis (MASH), fibrosis, and cirrhosis. However, many studies focus on older adults.
Objective:
To determine the frequency of screening for MASLD in young adults with T2D attending outpatient clinics.
Methods:
A retrospective cohort study on young adults (aged 18-44 years) with T2D who accessed care at a tertiary care center from January 1, 2018, to December 31, 2022. At-risk MASH was diagnosed with vibration-controlled transient elastography, magnetic resonance elastography, or liver biopsy.
Results:
Of 6891 participants included, 16% (n = 1100) had a diagnosis of MASLD. Those with MASLD were more likely to have cardiometabolic risk factors (83% vs 72%, P < .001) and cardiovascular disease (22% vs 16%, P < .001). Only 12% of those with MASLD underwent further investigation (1.9% of the total cohort), which was associated with dyslipidemia (odds ratio [OR], 2.4; 95% CI, 1.5-3.8), ALT >40 U/L (OR, 2.1; 95% CI, 1.4-3.0), or the use of 3 or more diabetes medications (OR, 2.1; 95% CI, 1.5-3.1). In those with further workup, 38% had at-risk MASH. The fibrosis-4 index was elevated in 16% of those with MASLD and only 28% of those with confirmed at-risk MASH or worse.
Conclusion:
Screening for MASLD in young adults with T2D is frequently missed. There is a lack of accurate noninvasive tools in this population. Increased awareness of screening young adults with T2D for at-risk MASH is urgently needed to prevent progression to cirrhosis.
Insights
Screening for metabolic dysfunction-associated steatotic liver disease (MASLD) is often missed in young adults with type 2 diabetes (T2D). Early detection of at-risk MASLD is crucial to prevent serious liver complications.
Area of Science:
- Hepatology
- Endocrinology
- Cardiology
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) affects 70% of adults with type 2 diabetes (T2D), increasing risks for MASH, fibrosis, and cirrhosis.
- Current research often overlooks the prevalence and screening of MASLD in younger adult populations with T2D.
Purpose of the Study:
- To assess the frequency of MASLD screening in young adults diagnosed with T2D who receive outpatient care.
- To highlight the need for improved screening protocols for MASLD in this demographic.
Main Methods:
- A retrospective cohort study analyzed data from young adults (18-44 years) with T2D treated at a tertiary care center between 2018 and 2022.
- At-risk metabolic dysfunction-associated steatohepatitis (MASH) was diagnosed using vibration-controlled transient elastography, MRE, or liver biopsy.
Main Results:
- Out of 6891 participants, 16% had MASLD, with higher rates of cardiometabolic risk factors and cardiovascular disease compared to those without MASLD.
- Only 12% of MASLD patients underwent further investigation, with dyslipidemia, elevated ALT, or multiple diabetes medications being significant associated factors.
- Among those investigated, 38% had at-risk MASH, and the FIB-4 index was elevated in 16% of MASLD patients.
Conclusions:
- Screening for MASLD in young adults with T2D is frequently inadequate.
- There's a critical need for enhanced awareness and accurate noninvasive tools for screening at-risk MASH in young adults with T2D to prevent disease progression.
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