Evaluation of Metabolic Dysfunction-Associated Steatotic Liver Disease in Patients with Type 2 Diabetes Mellitus

Year 2025, Volume: 15 Issue: 1, 71 - 77, 27.03.2025

Hüseyin Ali Öztürk , Erdinc Gulumsek , Dilan Damla Ozturk , Fatih Necip Arici , Begüm Şeyda Avci , Bektaş Işık , Mehmet Can Erişen , Bercem Berent Kaya , İrfan Alişan , Cahit Dincer , Ahmet Gazi Mustan , Tayyibe Saler , Hilmi Erdem Sümbül

https://doi.org/10.31832/smj.1636384

https://izlik.org/JA29AR88TL

Abstract

Aim: Diabetes mellitus (DM) is associated with the development and progression of metabolic dysfunction-associated steatotic liver disease (MASLD). In our study, we aimed to evaluate the findings of MASLD and fibrosis according to liver ultrasound (USG) imaging, FIB-4 score and fibroscan findings in patients with type 2 DM followed in our internal medicine clinic.
Methods: In our retrospective and cross-sectional study, 1282 patients diagnosed with type 2 DM whose anamnesis and previous examinations did not constitute an obstacle for inclusion in the study were included. The abdominal USG imaging of the patients were analysed from the system and the FIB-4 score was calculated. Liver stiffness (LS) measurements were performed with FibroScan® Mini 430 device (Echosens, France).
Results: USG imaging was performed in 474 (36.9%) of 1282 patients and MASLD was diagnosed in 341 (71.9%) of these patients. FIB-4 score> was 1.3 in 45 of 341 patients diagnosed with MASLD. Fibroscan imaging was performed in 231 of 341 patients with MASLD. In 52 (22.5%) of 231 patients, LS measurements> were 8 kPa
Conclusion: We recommend early screening of MASLD, which is associated with advanced fibrosis and increased cardiovascular mortality and morbidity in patients with DM, with liver USG, measurement of FIB-4 score and evaluation of LS with fibroscan in centres where possible.

Keywords

Diabetes mellitus , Fibroscan , FIB-4 , MASLD , USG

Ethical Statement

Adana City Training and Research Hospital Ethics Committee approved the study with decision number 319 dated 02.01.2025.

Tip 2 diabetes mellituslu hastalarda metabolik disfonksiyonla ilişkili steatotik karaciğer hastalığının değerlendirilmesi

https://izlik.org/JA29AR88TL

Abstract

Amaç: Diabetes mellitus (DM); metabolik disfonksiyonla ilişkili steatotik karaciğer hastalığı (MASLD) gelişimi ve hastalığın ilerlemesiyle ilişkilidir. Çalışmamızda iç hastalıkları kliniğimizde takip ettiğimiz tip 2 DM tanılı hastalarda karaciğer ultrason (USG) görüntülemesi, FIB-4 skoru ve fibroscan bulgularına göre MASLD ve fibrozis bulgularını değerlendirmeyi amaçladık.
Metod: Retrospektif ve kesitsel çalışmamıza, anamnez ve önceden yapılmış olan tetkiklerinde çalışmaya dâhil olmalarında engel bir durum teşkil etmeyen 1282 tip 2 DM tanılı hasta alındı. Hastaların sitemden abdomen USG görüntülemelerine bakıldı ve FIB-4 skoru hesaplandı. FibroScan® Mini 430 cihazı (Echosens, France) ile gerçekleştirilen karaciğer sertliği (LS) ölçümlerine bakıldı.
Bulgular: 1282 hastanın 474’ünde (36.9%) USG görüntülemesi yapılmış olup bu hastaların ise 341’inde (71.9%) MASLD tanısı konulmuştur. MASLD tanısı konulan 341 hastanın 45’inde FIB-4 skoru>1.3 idi. MASLD tanısı olan 341 hastanın 231’inde fibroscan görüntülemesi yapıldığı tespit edildi. 231 hastanın içerisinde 52 (22.5%) hastada LS ölçümleri >8 kPa idi
Sonuç: DM tanılı hastalarda ileri fibrozis ve artmış kardiyovasküler mortalite ve morbidite ile ilişkilendirilen MASLD’ın erken dönemde karaciğer USG ile taranmasını, FIB-4 skorunun ölçülmesini ve mümkün olan merkezlerde fibroscan ile LS değerlendirilmesini öneriyoruz.

Keywords

diyabetes mellitus , fibroscan , FIB-4 , MASLD , USG

Ethical Statement

Adana Şehir Eğitim ve Araştırma Hastanesi Etik Kurulu 02.01.2025 tarih ve 319 sayılı kararı ile çalışmayı onaylamıştır.

References

• Saeedi P, Petersohn I, Salpea P, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843. doi:10.1016/j.diabres.2019.107843
• Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966-1986. doi:10.1097/HEP.0000000000000520
• Şahintürk Y, Köker G, Koca N, et al. Metabolic Dysfunction-Associated Fatty Liver Disease and Fibrosis Status in Patients with Type 2 Diabetes Treated at Internal Medicine Clinics: Türkiye DAHUDER Awareness of Fatty Liver Disease (TR-DAFLD) Study. Turk J Gastroenterol. 2024;35(8):643-650. doi:10.5152/tjg.2024.24045
• Riazi K, Azhari H, Charette JH, et al. The prevalence and incidence of NAFLD worldwide: A systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2022;7(9):851-861. doi:10.1016/S2468-1253(22)00165-0
• Younossi ZM, Golabi P, de Avila L, et al. 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
• Zhang X, Yip TC, Tse YK, et al. Duration of type 2 diabetes and liver-related events in nonalcoholic fatty liver disease: A landmark analysis. Hepatology. 2023;78(6):1816-1827. doi:10.1097/HEP.0000000000000432
• Mantovani A, Petracca G, Beatrice G, Tilg H, Byrne CD, Targher G. Non-alcoholic fatty liver disease and risk of incident diabetes mellitus: An updated meta-analysis of 501 022 adult individuals. Gut. 2021;70(5):962-969. doi:10.1136/gutjnl-2020-322572
• European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492-542. doi:10.1016/j.jhep.2024.04.031
• Zoncapè M, Liguori A, Tsochatzis EA. Non-invasive testing and risk-stratification in patients with MASLD. Eur J Intern Med. 2024;122:11-19. doi:10.1016/j.ejim.2024.01.013
• American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(Suppl 1):S62-S69. doi:10.2337/dc10-S062
• Sezgin O, Akpınar H, Özer B, Törüner M, Bal K, Bor S. The Abdominal Ultrasonography Results of Cappadocia Cohort Study of Turkey Reveals High Prevalence of Fatty Liver. Turk J Gastroenterol. 2023;34(6):652-664. doi:10.5152/tjg.2023.23067
• Değertekin B, Tozun N, Demir F, et al. The Changing Prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) in Turkey in the Last Decade. Turk J Gastroenterol. 2021;32(3):302-312. doi:10.5152/tjg.2021.20062
• En Li Cho E, Ang CZ, Quek J, et al. Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus: An updated systematic review and meta-analysis. Gut. 2023;72(11):2138-2148. doi:10.1136/gutjnl-2023-330110
• Chen Z, Yu R, Xiong Y, Du F, Zhu S. A vicious circle between insulin resistance and inflammation in nonalcoholic fatty liver disease. Lipids Health Dis. 2017;16(1):203. doi:10.1186/s12944-017-0572-9
• European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388-1402. doi:10.1016/j.jhep.2015.11.004
• European Association for the Study of the Liver. EASL clinical practice guidelines on non-invasive tests for evaluation of liver disease severity and prognosis - 2021 update. J Hepatol. 2021;75(3):659-689. doi:10.1016/j.jhep.2021.05.025
• Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835. doi:10.1097/HEP.0000000000000323
• ElSayed NA, Aleppo G, Aroda VR, et al. Comprehensive medical evaluation and assessment of comorbidities: Standards of care in diabetes—2023. Diabetes Care. 2023;46(Suppl 1):S49-S67. doi:10.2337/dc23-S004 Correction in: Diabetes Care. 2023;46(9):1722. doi:10.2337/dc23-er09a Correction in: Diabetes Care. 2023;46(9):1718-1720. doi:10.2337/dc23-ad09
• Sumida Y, Nakajima A, Itoh Y. Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. World J Gastroenterol. 2014;20(2):475-485. doi:10.3748/wjg.v20.i2.475
• Geethakumari P, Kampa P, Parchuri R, et al. Accuracy of Ultrasonography vs. Elastography in Patients With Non-alcoholic Fatty Liver Disease: A Systematic Review. Cureus. 2022;14(10):e29967. Published 2022 Oct 6. doi:10.7759/cureus.29967
• Ciardullo S, Vergani M, Perseghin G. Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes: Screening, Diagnosis, and Treatment. J Clin Med. 2023;12(17):5597. Published 2023 Aug 27. doi:10.3390/jcm12175597
• Ciardullo S, Muraca E, Perra S, et al. Screening for non-alcoholic fatty liver disease in type 2 diabetes using non-invasive scores and association with diabetic complications. BMJ Open Diabetes Res Care. 2020;8(1):e000904. doi:10.1136/bmjdrc-2019-000904
• Ciardullo S, Perseghin G. Prevalence of elevated liver stiffness in patients with type 1 and type 2 diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract. 2022;190:109981. doi:10.1016/j.diabres.2022.109981
• Zhou XD, Targher G, Byrne CD, et al. An international multidisciplinary consensus statement on MAFLD and the risk of CVD. Hepatol Int. 2023;17(4):773-791. doi:10.1007/s12072-023-10543-8