MOST adults with Type 1 diabetes who are overweight or obese develop non-alcoholic fatty liver disease (NAFLD), according to new data. Michelle Lundholm, Cleveland Clinic, Ohio, USA, stated: “It is alarming how under-investigated and underdiagnosed NAFLD is in the population with Type 1 diabetes. We are missing opportunities to detect early NAFLD disease and apply cardiometabolic interventions to prevent irreversible liver damage.”
In a retrospective, cross-sectional study, Lundholm and colleagues obtained data from 447 adults with Type 1 diabetes from 2015–2018. They collected laboratory data, demographics, hepatology referrals, liver imaging, and liver biopsy of these participants. The team used the hepatic steatosis index (HSI) and Framingham steatosis index (FSI) as markers for steatosis, as well as the aspartate transaminase to plated ratio index and Fibrosis (FIB)-4 as fibrosis markers.
Results showed that 60.6% of participants had a positive HSI, while 6.5% had a negative and 32.9% had an indeterminate score. Furthermore, 51.5% of the cohort had a positive score and 48.5% had a negative score based on the FSI. The team then divided the participants into categories based on BMI, which showed that 22.3% of adults with normal weight had a positive HSI score, compared to 64.9% of those who were overweight, and all participants with obesity.
Data also showed that of 221 participants older than 35 years, 3.6% had a high FIB-4 score, 75.1% had a low score, and 21.3% had an indeterminate score. Regarding aspartate transaminase to platelet ratio index, 1.6% of participants had significant fibrosis and 2.5% had severe fibrosis. Researchers did not note differences in scores when dividing adults into BMI categories when it came for either of these markers.
The team identified multiple predictors for a positive hepatic steatosis index score such as female gender; older age; higher BMI; low high-density lipoprotein (HDL) cholesterol; and the presence of hyperlipidaemia, hypertension, and metabolic syndrome. Predictors for a positive FSI score were also determined, including older age, higher triglycerides, higher BMI, lower HDL cholesterol, higher triglyceride to HDL ratio, and the presence of hyperlipidaemia, hypertension, cardiovascular disease, and metabolic syndrome. The only predictor for high or indeterminate FIB-4 score was old age, and there were no predictors for significant or severe fibrosis with the aspartate transaminase to platelet ratio index.
The team concluded that NAFLD screening with liver scores, imaging, biopsies, and hepatology referrals needs to be integrated into routine diabetes care to ensure that disease is detected and treated at early stages.