High Prevalence of Advanced Liver Fibrosis Assessed by Transient Elastography Among U.S. Adults With Type 2 Diabetes

Abstract

<b>Objective:</b> Type 2 diabetes mellitus (T2DM) is an important risk factor for the progression of metabolic liver disease to advanced fibrosis. Here, we provide an estimate of the prevalence of steatosis and fibrosis in US adults with T2DM based on transient elastography (TE) and identify factors associated with these conditions. <p><b>Research Design and Methods: </b>This is a cross-sectional study of US adults with T2DM participating in the 2017-2018 cycle of the National Health and Nutrition Examination Survey who were evaluated by TE. Hepatic steatosis and fibrosis were diagnosed by the median value of Controlled Attenuation Parameter (CAP) and Liver Stiffness Measurement (LSM), respectively.</p> <p><b>Results:</b> Among the 825 patients with reliable TE exams, 484 (53.7%) were assessed using the M probe and 341 (46.3%) using the XL probe. Liver steatosis (CAP≥274 dB/m), advanced fibrosis (LSM≥9.7 Kpa) and cirrhosis (LSM≥13.6 Kpa) were present in 73.8% (95% CI 68.5%-78.5%), 15.4% (95% CI 12.2%-19.0%) and 7.7% (95% CI 4.8%-11.9%) of patients, respectively. Mean age of patients with advanced fibrosis and cirrhosis was 63.7 ± 2.2 years and 57.8 ± 1.6 years, respectively. In the multivariable logistic regression model, body mass index (BMI), non-African American ethnicity and alanine aminotransferase levels were independent predictors of steatosis, while BMI, non-African American ethnicity, aspartate aminotransferase and gamma-glutamyltranspeptidase levels were independent predictors of advanced fibrosis.</p> <p><b>Conclusions:</b> Prevalence of both liver steatosis and fibrosis are high in patients with T2DM from the US and obesity is a major risk factor. Our results support the screening of these conditions among diabetic patients.</p>