Screening for Liver Fibrosis and Steatosis in a Large Cohort of Patients with Type 2 Diabetes Using Vibration Controlled Transient Elastography and Controlled Attenuation Parameter in a Single-Center Real-Life Experience.

Ioan Sporea,Alina Popescu,Silviu Nistorescu,Victor Baldea,Ruxandra Mare,Alexandra Sima,Adina Braha,Roxana Sirli,Raluca Lupusoru,Romulus Timar

doi:10.3390/jcm9041032

Abstract

Background: Type 2 diabetes mellitus (T2DM), obesity, hyperlipidemia, and hypertension are considered risk factors for developing non-alcoholic fatty liver disease (NAFLD). This study aims to assess steatosis and fibrosis severity in a cohort of T2DM patients, using vibration controlled transient elastography (VCTE) and controlled attenuation parameter (CAP). Material and method: We performed a prospective study in which, in each patient, we aimed for 10 valid CAP and liver stiffness measurements (LSM). To discriminate between fibrosis stages, we used the following VCTE cut-offs: F ≥ 2–8.2 kPa, F ≥ 3–9.7 kPa, and F4 - 13.6 kPa. To discriminate between steatosis stages, we used the following CAP cut-offs: S1 (mild) – 274 dB/m, S2 (moderate) – 290dB/m, S3 (severe) – 302dB/m. Results: During the study period, we screened 776 patients; 60.3% had severe steatosis, while 19.4% had advanced fibrosis. Female gender, BMI, waist circumference, elevated levels of AST, total cholesterol, triglycerides, blood glucose, and high LSM were associated with severe steatosis (all p-value < 0.05). BMI, waist circumference, elevated levels of AST, HbA1c, and CAP were associated with advanced fibrosis (all p-values < 0.05). Conclusion: Higher BMI (obesity) comprises a higher risk of developing severe steatosis and fibrosis. Individualized screening strategies should be established for NAFLD according to different BMI.

Highlights

The incidence of overweight and obesity has been increasing in the past decades in developed countries
Our study aims to evaluate the incidence of steatosis and fibrosis and the factors associated with these conditions in a large cohort of Type 2 diabetes mellitus (T2DM) patients, using vibration controlled transient elastography (VCTE) and controlled attenuation parameter (CAP)
For the entire cohort we found that female gender (p = 0.02), body mass index (BMI) (p = 0.03), waist circumference (p < 0.0001), elevated levels of AST (p = 0.03), total cholesterol (p = 0.01), triglycerides (p < 0.0001), blood glucose (p = 0.0009), and high liver stiffness measurements (LSM) (p = 0.0006) were associated with severe steatosis (Table 3)

Summary

Introduction

The incidence of overweight and obesity has been increasing in the past decades in developed countries. The frequency of type 2 diabetes mellitus (T2DM) is increasing. Type 2 diabetes mellitus (T2DM), obesity, hyperlipidemia, and hypertension are considered risk factors for developing non-alcoholic fatty liver disease (NAFLD). This study aims to assess steatosis and fibrosis severity in a cohort of T2DM patients, using vibration controlled transient elastography (VCTE) and controlled attenuation parameter (CAP). Results: During the study period, we screened 776 patients; 60.3% had severe steatosis, while 19.4% had advanced fibrosis. BMI, waist circumference, elevated levels of AST, total cholesterol, triglycerides, blood glucose, and high LSM were associated with severe steatosis (all p-value < 0.05). BMI, waist circumference, elevated levels of AST, HbA1c, and CAP were associated with advanced fibrosis (all p-values < 0.05). Conclusion: Higher BMI (obesity) comprises a higher risk of developing severe steatosis and fibrosis. Individualized screening strategies should be established for NAFLD according to different BMI

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Conclusion