DAFNE Unit, Clinical Care Research and Clinical Trials Unit, Dasman Diabetes Institute, Kuwait City, Kuwait.
Amiri Hospital, Ministry of Health, Kuwait City, Kuwait.
Diabetes Obes Metab. 2024 Sep;26(9):4052-4059. doi: 10.1111/dom.15760. Epub 2024 Jul 10.
To compare hepatic stiffness and fat fraction in patients with obesity and type 1 diabetes (T1D) with type 2 diabetes (T2D) with a similar body mass index (BMI).
In this prospective cross-sectional study, 90 participants with T1D (BMI 30.5 ± 4.5 kg/m; diabetes duration 20.5 ± 9.8 years; HbA1c 8.2% ± 1.4%) and 69 with T2D (BMI: 30.8 ± 4.6 kg/m; diabetes duration: 11.7 ± 7.8 years; HbA1c: 7.3% ± 1.4%) were included. Liver fat fraction and stiffness were examined by magnetic resonance imaging and elastography, respectively. Logistic regressions were used to evaluate associations with biomedical variables.
The mean liver stiffness score in patients with obesity and T1D was 2.2 ± 0.5 kPa, while in T2D it was 2.6 ± 0.8 kPa (P < .001). The liver fat fraction in patients with obesity and T1D was 3.7% ± 6.3%, and in T2D it was 10.6% ± 7.9% (P < .001). Metabolic dysfunction-associated steatotic liver disease (MASLD) was present in 13.3% of patients with T1D and in 69.6% of patients with T2D, whereas fibrosis was suggested in 7.8% of patients with T1D and in 27.5% of patients with T2D. Liver stiffness was four times higher in patients with T2D compared with those with T1D (odds ratio = 5.4, 95% confidence interval: 2.1-13.6, P < .001). Aspartate transaminase (AST), alanine transaminase, gamma-glutamyl transferase (GGT), triglycerides and the android-to-gynoid ratio were associated with elevated fat fraction in both cohorts. AST and GGT were associated with elevated liver stiffness in both cohorts.
Patients with obesity and T1D had lower liver fat and liver stiffness compared with those patients with T2D, despite similar levels of BMI, a longer duration of diabetes and worse glycaemic control.
比较肥胖合并 1 型糖尿病（T1D）与肥胖合并 2 型糖尿病（T2D）患者的肝硬度和脂肪分数，这些患者的体质量指数（BMI）相似。
在这项前瞻性的横断面研究中，纳入了 90 名肥胖合并 T1D 患者（BMI 30.5±4.5kg/m；糖尿病病程 20.5±9.8 年；糖化血红蛋白 8.2%±1.4%）和 69 名肥胖合并 T2D 患者（BMI：30.8±4.6kg/m；糖尿病病程：11.7±7.8 年；糖化血红蛋白：7.3%±1.4%）。通过磁共振成像和弹性成像分别检查肝脏脂肪分数和肝硬度。采用逻辑回归评估与生物医学变量的关联。
肥胖合并 T1D 患者的平均肝硬度评分为 2.2±0.5kPa，而肥胖合并 T2D 患者的肝硬度评分为 2.6±0.8kPa（P<0.001）。肥胖合并 T1D 患者的肝脏脂肪分数为 3.7%±6.3%，而肥胖合并 T2D 患者的肝脏脂肪分数为 10.6%±7.9%（P<0.001）。13.3%的 T1D 患者和 69.6%的 T2D 患者存在代谢相关脂肪性肝病（MASLD），7.8%的 T1D 患者和 27.5%的 T2D 患者存在纤维化。与 T1D 患者相比，T2D 患者的肝硬度高 4 倍（比值比=5.4，95%置信区间：2.1-13.6，P<0.001）。天门冬氨酸转氨酶（AST）、丙氨酸转氨酶、γ-谷氨酰转移酶（GGT）、甘油三酯和男性向女性型体脂分布比值在两个队列中均与脂肪分数升高相关。AST 和 GGT 在两个队列中均与肝硬度升高相关。
肥胖合并 T1D 患者的肝脏脂肪和肝硬度低于肥胖合并 T2D 患者，尽管这些患者的 BMI、糖尿病病程和血糖控制水平相似。
