Souza Matheus, Al-Sharif Lubna, Khalil Samira Mohamad, Villela-Nogueira Cristiane Alves, Mantovani Alessandro
Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Faculty of Medicine and Health Sciences, Department of Biomedical Sciences and Basic Clinical Skills, An-Najah National University, Nablus, Palestine.
Clin Gastroenterol Hepatol. 2025 Jul;23(8):1308-1319.e17. doi: 10.1016/j.cgh.2024.09.038. Epub 2024 Dec 11.
BACKGROUND & AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) is often overlooked in patients with type 1 diabetes mellitus (T1DM). Our study aims to provide a comprehensive overview of the burden of MASLD in T1DM by assessing the prevalence of MASLD and its advanced forms in individuals with T1DM.
We systematically searched PubMed and Embase databases (from inception to May 5, 2024) for original articles on the prevalence or characteristics of MASLD (as detected by blood biomarkers/scores, imaging techniques, or liver biopsy) in adults with T1DM. Data were extracted, and we performed a meta-analysis of proportions using generalized linear mixed model, and pairwise meta-analysis using the DerSimonian-Laird method. Heterogeneity was investigated with further subgroup and meta-regression analyses, and publication bias was assessed.
We identified 23 studies for a total of 13,006 individuals with T1DM. Of these, 22.24% (95% confidence interval [CI], 15.62-30.66; I = 99.2%) had MASLD. Significant fibrosis (≥F2) and advanced fibrosis (≥F3) were found in 13.25% (95% CI, 11.15-15.67; I = 0%) and 5.12% (95% CI, 3.78-6.91; I = 0%) of patients with T1DM and MASLD, respectively. Patients with MASLD and T1DM were more likely to be older, overweight, male, have a longer duration of diabetes, require higher daily doses of insulin, have metabolic dysfunction, and were at a higher risk of microvascular complications.
MASLD is relatively common in T1DM. Patients with MASLD-T1DM have a distinct clinical profile compared with those with T1DM, with only a small proportion having significant or advanced fibrosis.
代谢功能障碍相关脂肪性肝病（MASLD）在1型糖尿病（T1DM）患者中常被忽视。我们的研究旨在通过评估T1DM患者中MASLD及其晚期形式的患病率，全面概述T1DM中MASLD的负担。
我们系统检索了PubMed和Embase数据库（从数据库建立至2024年5月5日），以查找关于T1DM成年患者中MASLD患病率或特征（通过血液生物标志物/评分、成像技术或肝活检检测）的原始文章。提取数据后，我们使用广义线性混合模型进行比例的荟萃分析，并使用DerSimonian-Laird方法进行成对荟萃分析。通过进一步的亚组和荟萃回归分析研究异质性，并评估发表偏倚。
我们纳入了23项研究，共涉及13006例T1DM患者。其中，22.24%（95%置信区间[CI]，15.62 - 30.66；I² = 99.2%）患有MASLD。在患有T1DM和MASLD的患者中，分别有13.25%（95% CI，11.15 - 15.67；I² = 0%）和5.12%（95% CI，3.78 - 6.91；I² = 0%）存在显著纤维化（≥F2）和重度纤维化（≥F3）。患有MASLD和T1DM的患者更可能年龄较大、超重、为男性、糖尿病病程较长、每日胰岛素剂量较高、存在代谢功能障碍，并且微血管并发症风险较高。
MASLD在T1DM中相对常见。与T1DM患者相比，患有MASLD - T1DM的患者具有独特的临床特征，只有一小部分患者存在显著或重度纤维化。
