NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA; Division of Gastroenterology and Hepatology, University of California at San Diego, La Jolla, CA, USA.
NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA.
J Hepatol. 2023 Mar;78(3):471-478. doi: 10.1016/j.jhep.2022.11.010. Epub 2022 Nov 19.
BACKGROUND & AIMS: There are limited prospective data on patients with type 2 diabetes mellitus (T2DM) specifically enrolled and systematically assessed for advanced fibrosis or cirrhosis due to non-alcoholic fatty liver disease (NAFLD). Therefore, we aimed to evaluate the prevalence of advanced fibrosis and cirrhosis in a prospectively recruited cohort of adults with T2DM.
This prospective study enrolled adults aged ≥50 years with T2DM, recruited from primary care or endocrinology clinics. Participants underwent a standardized clinical research visit with MRI-proton density fat fraction (MRI-PDFF), magnetic resonance elastography (MRE), vibration-controlled transient elastography (VCTE) and controlled-attenuation parameter. NAFLD was defined as MRI-PDFF ≥5% after exclusion of other liver diseases. Advanced fibrosis and cirrhosis were defined by established liver stiffness cut-off points on MRE or VCTE if MRE was not available.
Of 524 patients screened, 501 adults (63% female) with T2DM met eligibility. The mean age and BMI were 64.6 (±8.1) years and 31.4 (±5.9) kg/m, respectively. The prevalence of NAFLD, advanced fibrosis and cirrhosis was 65%, 14% and 6%, respectively. In multivariable adjusted models, adjusted for age and sex, obesity and insulin use were associated with increased odds of advanced fibrosis (odds ratio 2.50; 95% CI 1.38-4.54; p = 0.003 and odds ratio 2.71; 95% CI 1.33-5.50; p = 0.006, respectively). Among 29 patients with cirrhosis, two were found to have hepatocellular carcinoma and one patient had gallbladder adenocarcinoma.
Utilizing a uniquely well-phenotyped prospective cohort of patients aged ≥50 years with T2DM, we found that the prevalence of advanced fibrosis was 14% and that of cirrhosis was 6%. These data underscore the high risk of advanced fibrosis/cirrhosis in adults aged ≥50 years with T2DM.
Non-alcoholic fatty liver disease (NAFLD) is common in patients with type 2 diabetes (T2DM), however, there are limited prospective data characterizing the prevalence of advanced fibrosis and cirrhosis using the most accurate non-invasive biomarkers of liver fat and fibrosis. We show that 14% of older adults with T2DM have advanced fibrosis and 6% have cirrhosis, which places them at risk for liver failure and liver cancer. Accurate prevalence rates and comparative analysis regarding the diagnostic accuracy of non-invasive tests in this population will guide the optimal screening strategy and future cost-effectiveness analyses. These results will inform future Hepatology and Endocrinology practice guidelines regarding NAFLD screening programs in older adults with T2DM.
由于非酒精性脂肪性肝病（NAFLD），专门招募和系统评估 2 型糖尿病（T2DM）患者的先进纤维化或肝硬化的前瞻性数据有限。因此，我们旨在评估前瞻性招募的 T2DM 成年患者中先进纤维化和肝硬化的患病率。
这项前瞻性研究纳入了年龄≥50 岁的 T2DM 成年患者，他们来自初级保健或内分泌科诊所。参与者接受了标准的临床研究访问，包括 MRI 质子密度脂肪分数（MRI-PDFF）、磁共振弹性成像（MRE）、振动控制瞬态弹性成像（VCTE）和受控衰减参数。NAFLD 的定义是排除其他肝脏疾病后 MRI-PDFF≥5%。如果没有 MRE，则通过 MRE 或 VCTE 上已建立的肝硬度截断值来定义先进的纤维化和肝硬化。
在筛选的 524 名患者中，有 501 名患有 T2DM 的成年患者（63%为女性）符合入选标准。平均年龄和 BMI 分别为 64.6（±8.1）岁和 31.4（±5.9）kg/m²。NAFLD、先进纤维化和肝硬化的患病率分别为 65%、14%和 6%。在多变量调整模型中，调整年龄和性别后，肥胖和胰岛素使用与先进纤维化的几率增加相关（比值比 2.50；95%CI 1.38-4.54；p=0.003 和比值比 2.71；95%CI 1.33-5.50；p=0.006）。在 29 例肝硬化患者中，有 2 例发现肝癌，1 例发现胆囊腺癌。
利用一个独特的表型良好的前瞻性队列，对年龄≥50 岁的 T2DM 患者进行研究，我们发现先进纤维化的患病率为 14%，肝硬化的患病率为 6%。这些数据突出表明，≥50 岁的 T2DM 成年患者中先进纤维化/肝硬化的风险很高。
非酒精性脂肪性肝病（NAFLD）在 2 型糖尿病（T2DM）患者中很常见，然而，使用最准确的非侵入性肝脂肪和纤维化生物标志物来描述先进纤维化和肝硬化的患病率的前瞻性数据有限。我们发现，14%的老年 T2DM 患者患有先进纤维化，6%的患者患有肝硬化，这使他们面临肝衰竭和肝癌的风险。在该人群中，准确的患病率以及关于非侵入性检测的诊断准确性的比较分析，将指导最佳筛查策略和未来的成本效益分析。这些结果将为老年 T2DM 患者的 NAFLD 筛查计划提供未来的肝病学和内分泌学实践指南。
