Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
Metabolic Diseases, Department of Medicine, University of Padua, Padua, Italy.
Diabetes Metab. 2024 Jan;50(1):101497. doi: 10.1016/j.diabet.2023.101497. Epub 2023 Nov 20.
We examined whether metabolic dysfunction-associated steatotic liver disease (MASLD) with or without significant fibrosis (assessed by validated non-invasive biomarkers) was associated with an increased risk of prevalent chronic kidney disease (CKD) or diabetic retinopathy in people with type 1 diabetes mellitus (T1DM).
We performed a retrospective multicenter cross-sectional study involving 1,409 adult outpatients with T1DM, in whom hepatic steatosis index (HSI) and fibrosis (FIB)-4 index were calculated for non-invasively detecting hepatic steatosis (defined by HSI > 36), with or without coexisting significant fibrosis (FIB-4 index ≥ 1.3 or < 1.3). CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m or urine albumin/creatinine ratio ≥ 3.0 mg/mmol. The presence of diabetic retinopathy was also recorded in all participants.
Patients with MASLD and significant fibrosis (n = 93) had a remarkably higher prevalence of CKD and diabetic retinopathy than their counterparts with MASLD without fibrosis (n = 578) and those without steatosis (n = 738). After adjustment for sex, diabetes duration, hemoglobin A1c, hypertension, and use of antihypertensive or lipid-lowering medications, patients with SLD and significant fibrosis had a higher risk of prevalent CKD (adjusted-odds ratio 1.76, 95 % confidence interval 1.05-2.96) than those without steatosis. Patients with MASLD without fibrosis had a higher risk of prevalent retinopathy (adjusted-odds ratio 1.49, 95 % CI 1.13-1.46) than those without steatosis.
This is the largest cross-sectional study showing that MASLD with and without coexisting significant fibrosis was associated, independently of potential confounders, with an increased risk of prevalent CKD and retinopathy in adults with T1DM.
我们研究了代谢相关脂肪性肝病（MASLD）合并或不合并显著纤维化（通过验证的非侵入性生物标志物评估）是否与 1 型糖尿病（T1DM）患者中普遍存在的慢性肾脏病（CKD）或糖尿病视网膜病变的风险增加有关。
我们进行了一项回顾性多中心横断面研究，纳入了 1409 名成年 T1DM 门诊患者，他们的肝脂肪变性指数（HSI）和纤维化（FIB）-4 指数被用于非侵入性地检测肝脂肪变性（定义为 HSI＞36），并伴有或不伴有共存的显著纤维化（FIB-4 指数≥1.3 或＜1.3）。CKD 的定义为估计肾小球滤过率（eGFR）＜60ml/min/1.73m2或尿白蛋白/肌酐比值≥3.0mg/mmol。所有参与者均记录了糖尿病视网膜病变的存在情况。
患有 MASLD 伴显著纤维化的患者（n=93）比 MASLD 无纤维化的患者（n=578）和无脂肪变性的患者（n=738）的 CKD 和糖尿病视网膜病变的患病率显著更高。在校正性别、糖尿病病程、糖化血红蛋白、高血压以及使用降压或降脂药物后，患有 SLD 伴显著纤维化的患者发生普遍 CKD 的风险更高（调整后优势比 1.76，95%置信区间 1.05-2.96），而无脂肪变性的患者发生普遍 CKD 的风险更高。患有 MASLD 无纤维化的患者发生普遍视网膜病变的风险更高（调整后优势比 1.49，95%置信区间 1.13-1.46），而无脂肪变性的患者发生普遍视网膜病变的风险更高。
这是最大的横断面研究，表明 MASLD 合并或不合并共存显著纤维化与 T1DM 成人普遍存在的 CKD 和视网膜病变风险增加有关，且独立于潜在的混杂因素。
