Identifying Metabolic Dysfunction-associated Steatotic Liver Disease in Patients with Type 2 Diabetes Mellitus Using Clinic-based Prediction Tools

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2024 Oct 10

PMID 39386740

Authors

Juma Alkaabi

Bachar Afandi

Omar Alhaj

Darakhshan Kanwal

Adnan Agha

Affiliations

Soon will be listed here.

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is a global cause of chronic liver disease. The prevalence of MASLD is high in patients with type 2 diabetes mellitus (T2DM). Various non-invasive tools such as the fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS), liver ultrasound, and FibroScan can aid in the detection of liver fibrosis in MASLD, while the Hamaguchi ultrasound-based liver grading system has demonstrated high sensitivity and specificity comparable to liver biopsy.

Objective: We assessed the frequency of MASLD in patients with T2DM using the liver ultrasound Hamaguchi score and the accuracy of NFS and Fib-4 in identifying MASLD.

Patients And Methods: We retrospectively collected data and reviewed the charts of all patients with T2DM who underwent liver ultrasound and laboratory tests during the past 5 years.

Results: A total of 6,214 medical records were screened, and only 153 patients (68.6% women; mean age, 59 ± 12.2 years) fulfilled the selection criteria. MASLD was diagnosed using the Hamaguchi grading criteria in 45.1% of patients. A high/intermediate NFS had a higher sensitivity (79.7%) for diagnosing MASLD with a specificity of 10.7%, while a high/intermediate Fib-4 score showed only 30.4% sensitivity but a higher specificity of 54.8%.

Conclusion: Our study indicates that MASLD is frequent in patients with T2DM, and clinical prediction tools such as NFS and Fib-4 can be applied in clinic/primary care settings with variable results.

References

McPherson S, Stewart S, Henderson E, Burt A, Day C . Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut. 2010; 59(9):1265-9. DOI: 10.1136/gut.2010.216077. View

Sun W, Cui H, Li N, Wei Y, Lai S, Yang Y . Comparison of FIB-4 index, NAFLD fibrosis score and BARD score for prediction of advanced fibrosis in adult patients with non-alcoholic fatty liver disease: A meta-analysis study. Hepatol Res. 2016; 46(9):862-70. DOI: 10.1111/hepr.12647. View

Hagstrom H, Adams L, Allen A, Byrne C, Chang Y, Duseja A . The future of International Classification of Diseases coding in steatotic liver disease: An expert panel Delphi consensus statement. Hepatol Commun. 2024; 8(2). PMC: 10843430. DOI: 10.1097/HC9.0000000000000386. View

Chalasani N, Younossi Z, Lavine J, Charlton M, Cusi K, Rinella M . The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2017; 67(1):328-357. DOI: 10.1002/hep.29367. View

Zhou J, Cai J, She Z, Li H . Noninvasive evaluation of nonalcoholic fatty liver disease: Current evidence and practice. World J Gastroenterol. 2019; 25(11):1307-1326. PMC: 6429343. DOI: 10.3748/wjg.v25.i11.1307. View

Kanwal F, Shubrook J, Adams L, Pfotenhauer K, Wong V, Wright E . Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology. 2021; 161(5):1657-1669. PMC: 8819923. DOI: 10.1053/j.gastro.2021.07.049. View

Younossi Z, Golabi P, de Avila L, Paik J, Srishord M, Fukui N . The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis. J Hepatol. 2019; 71(4):793-801. DOI: 10.1016/j.jhep.2019.06.021. View

Castera L, Forns X, Alberti A . Non-invasive evaluation of liver fibrosis using transient elastography. J Hepatol. 2008; 48(5):835-47. DOI: 10.1016/j.jhep.2008.02.008. View

. EASL-EASD-EASO Clinical Practice Guidelines for the Management of Non-Alcoholic Fatty Liver Disease. Obes Facts. 2016; 9(2):65-90. PMC: 5644799. DOI: 10.1159/000443344. View

10.

Hamaguchi M, Kojima T, Itoh Y, Harano Y, Fujii K, Nakajima T . The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation. Am J Gastroenterol. 2007; 102(12):2708-15. DOI: 10.1111/j.1572-0241.2007.01526.x. View

11.

Rinella M, Neuschwander-Tetri B, Siddiqui M, Abdelmalek M, Caldwell S, Barb D . AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023; 77(5):1797-1835. PMC: 10735173. DOI: 10.1097/HEP.0000000000000323. View

12.

Musso G, Gambino R, Cassader M, Pagano G . Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med. 2010; 43(8):617-49. DOI: 10.3109/07853890.2010.518623. View

13.

Kaswala D, Lai M, Afdhal N . Fibrosis Assessment in Nonalcoholic Fatty Liver Disease (NAFLD) in 2016. Dig Dis Sci. 2016; 61(5):1356-64. DOI: 10.1007/s10620-016-4079-4. View

14.

Kramer H, Pickhardt P, Kliewer M, Hernando D, Chen G, Zagzebski J . Accuracy of Liver Fat Quantification With Advanced CT, MRI, and Ultrasound Techniques: Prospective Comparison With MR Spectroscopy. AJR Am J Roentgenol. 2016; 208(1):92-100. PMC: 5204456. DOI: 10.2214/AJR.16.16565. View

15.

Younossi Z, Koenig A, Abdelatif D, Fazel Y, Henry L, Wymer M . Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2015; 64(1):73-84. DOI: 10.1002/hep.28431. View

16.

Cadranel J, Rufat P, Degos F . Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF). Hepatology. 2000; 32(3):477-81. DOI: 10.1053/jhep.2000.16602. View

17.

Xiao G, Zhu S, Xiao X, Yan L, Yang J, Wu G . Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: A meta-analysis. Hepatology. 2017; 66(5):1486-1501. DOI: 10.1002/hep.29302. View

18.

. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016; 64(6):1388-402. DOI: 10.1016/j.jhep.2015.11.004. View

19.

Hernaez R, Lazo M, Bonekamp S, Kamel I, Brancati F, Guallar E . Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology. 2011; 54(3):1082-1090. PMC: 4197002. DOI: 10.1002/hep.24452. View

20.

Kanwal F, Neuschwander-Tetri B, Loomba R, Rinella M . Metabolic dysfunction-associated steatotic liver disease: Update and impact of new nomenclature on the American Association for the Study of Liver Diseases practice guidance on nonalcoholic fatty liver disease. Hepatology. 2024; 79(5):1212-1219. DOI: 10.1097/HEP.0000000000000670. View