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

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

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

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

References

1. 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
2. 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
3. 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
4. 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
5. 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
6. 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
7. 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
8. 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

9. 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
10. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(Suppl 1):S62-S69. doi:10.2337/dc10-S062
11. 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
12. 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
13. 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
14. 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
15. 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
16. 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
17. 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
18. 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
19. 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
20. 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
21. 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
22. 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
23. 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
24. 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