Khan Farooq, Dsouza Stafny, Khamis Amar Hassan, Abdul Fatima, Farooqi Muhammad Hamed, Sulaiman Fatima, Mulla Fahad, Al Awadi Fatheya, Hassanein Mohammed, Bayoumi Riad
Hepatology, King's College Hospital London, Dubai, United Arab Emirates.
College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
J Gen Intern Med. 2025 Jan 22. doi: 10.1007/s11606-025-09348-2.
BACKGROUND: Type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD), which have a reciprocal relationship compounded by obesity, are highly prevalent in the Middle East affecting morbidity, mortality, and healthcare costs. OBJECTIVE: This study aimed to assess the severity of MASLD and liver fibrosis among adult Emirati patients with long-standing T2DM. DESIGN AND PARTICIPANTS: This cross-sectional study used noninvasive methods to assess the severity of MASLD and fibrosis progression in an adult cohort of Emirati patients (N = 546) with a mean T2DM duration of 16 years. MAIN MEASURES: Fatty liver infiltration was assessed by hepatic steatosis index (HSI), while fibrosis was assessed by the fibrosis-4 (FIB-4) index and aspartate aminotransferase/platelet ratio index (APRI). Of those, 108 patients were randomly subjected to ultrasound-based FibroScan to assess controlled attenuation parameter (CAP) and liver stiffness measurement (LSM). KEY RESULTS: All patients had fatty liver with ~ 83% being categorized as having severe steatosis. Serum-based fibrosis biomarker panels detected significant liver fibrosis in ~ 2.5% of these patients. The APRI appeared to be more restrictive in detecting moderate fibrosis (1.5%) than the FIB-4 index (25.5%). CAP significantly correlated with the LSM, indicating that the two methods contributed to the same underlying pathophysiology. Liver steatosis was more severe in female patients, who were older and had a higher body mass index (BMI) than those with moderate or no significant fibrosis. They also had higher serum liver enzymes and were more likely to have age-related changes in kidney function. Interestingly, severity of both steatosis and fibrosis remained unaffected by age and duration of T2D except for fibrosis severity detected by FibroScan. CONCLUSIONS: This study highlights the critical need for routine screening of MASLD among Emirati patients with long-standing T2DM, given the high point prevalence of severe steatosis (~ 83%), predominantly among women in this population.
背景：2型糖尿病（T2DM）和代谢功能障碍相关脂肪性肝病（MASLD）相互关联，且因肥胖而加剧，在中东地区极为普遍，影响发病率、死亡率和医疗成本。 目的：本研究旨在评估成年阿联酋长期患T2DM患者中MASLD和肝纤维化的严重程度。 设计与参与者：这项横断面研究采用非侵入性方法评估成年阿联酋患者队列（N = 546）中MASLD的严重程度和纤维化进展情况，这些患者的T2DM平均病程为16年。 主要测量指标：通过肝脏脂肪变性指数（HSI）评估脂肪肝浸润情况，通过纤维化-4（FIB-4）指数和天冬氨酸氨基转移酶/血小板比值指数（APRI）评估纤维化情况。其中108例患者被随机进行基于超声的FibroScan检查，以评估受控衰减参数（CAP）和肝脏硬度测量值（LSM）。 主要结果：所有患者均有脂肪肝，约83%被归类为重度脂肪变性。基于血清的纤维化生物标志物检测发现，这些患者中约2.5%存在显著肝纤维化。APRI在检测中度纤维化（1.5%）方面似乎比FIB-4指数（25.5%）更具局限性。CAP与LSM显著相关，表明这两种方法反映了相同的潜在病理生理学机制。女性患者的肝脏脂肪变性更严重，她们比中度或无显著纤维化的患者年龄更大，体重指数（BMI）更高。她们的血清肝酶也更高，且更有可能出现与年龄相关的肾功能变化。有趣的是，除了FibroScan检测到的纤维化严重程度外，脂肪变性和纤维化的严重程度均不受T2D年龄和病程的影响。 结论：鉴于严重脂肪变性（约83%）的高现患率，主要发生在该人群中的女性，本研究强调了对成年阿联酋长期患T2DM患者进行MASLD常规筛查的迫切需求。
Cardiovasc Diabetol. 2024-9-28
J Hepatol. 2024-2
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