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. 2023 Apr 7;5(7):100753.
doi: 10.1016/j.jhepr.2023.100753. eCollection 2023 Jul.

Prevalence, risk factors and diagnostic accuracy of non-invasive tests for NAFLD in people with type 1 diabetes

Jonathan Mertens  1   2   3 , Jonas Weyler  2   3 , Eveline Dirinck  1   2 , Luisa Vonghia  2   3 , Wilhelmus J Kwanten  2   3 , Laura Mortelmans  3 , Cedric Peleman  2   3 , Shivani Chotkoe  2 , Maarten Spinhoven  4 , Floris Vanhevel  4 , Luc F Van Gaal  1 , Benedicte Y De Winter  2 , Christophe E M De Block  1   2 , Sven M Francque  2   3
Affiliations

Prevalence, risk factors and diagnostic accuracy of non-invasive tests for NAFLD in people with type 1 diabetes

Jonathan Mertens et al. JHEP Rep. .

Erratum in

Abstract

Background & aims: The epidemiology of non-alcoholic fatty liver disease (NAFLD) in people with type 1 diabetes (T1D) is not yet elucidated. This study aimed to assess the diagnostic accuracy of non-invasive tests for NAFLD, to investigate the prevalence and severity of NAFLD, and to search for factors contributing to NAFLD in people with T1D.

Methods: In this prospective cohort study, we consecutively screened 530 adults with T1D from a tertiary care hospital, using ultrasound (US), vibration-controlled transient elastography equipped with liver stiffness measurement (LSM) and controlled attenuation parameter, and the fatty liver index. Magnetic resonance spectroscopy (MRS) was performed in a representative subgroup of 132 individuals to validate the diagnostic accuracy of the non-invasive tests.

Results: Based on MRS as reference standard, US identified individuals with NAFLD with an AUROC of 0.98 (95% CI 0.95-1.00, sensitivity: 1.00, specificity: 0.96). The controlled attenuation parameter was also accurate with an AUROC of 0.85 (95% CI 0.77-0.93). Youden cut-off was ≥270 dB/m (sensitivity: 0.90, specificity: 0.74). The fatty liver index yielded a similar AUROC of 0.83 (95% CI 0.74-0.91), but the conventional cut-off used to rule in (≥60) had low sensitivity and specificity (0.62, 0.78). The prevalence of NAFLD in the overall cohort was 16.2% based on US. Metabolic syndrome was associated with NAFLD (OR: 2.35 [1.08-5.12], p = 0.031). The overall prevalence of LSM ≥8.0 kPa indicating significant fibrosis was 3.8%, but reached 13.2% in people with NAFLD.

Conclusions: NAFLD prevalence in individuals with T1D is 16.2%, with approximately one in 10 featuring elevated LSM. US-based screening could be considered in people with T1D and metabolic syndrome.

Impact and implications: We aimed to report on the prevalence, disease severity, and risk factors of NAFLD in type 1 diabetes (T1D), while also tackling which non-invasive test for NAFLD is the most accurate. We found that ultrasound is the best test to diagnose NAFLD. NAFLD prevalence is 16.2%, and is associated with metabolic syndrome and BMI. Elevated liver stiffness indicating fibrosis is overall not prevalent in people with T1D (3.8%), but it reaches 13.2% in those with T1D and NAFLD.

Keywords: Liver fibrosis; MRI; Metabolic syndrome; NAFLD; Transient elastography; Type 1 diabetes mellitus.

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Conflict of interest statement

ED has served as a consultant for Novo Nordisk, Ely Lilly, and Boehringer Ingelheim. WK is co-inventor of a patent on the use of lipopigment imaging for disease filed by MIT/MGH. LVG declares to be member of the Advisory Board and/or Speakers Bureau of AstraZeneca, Boehringer Ingelheim, Eli Lilly, MSD, and Novo Nordisk. CDB reports consulting fees and honoraria for speaking for Abbott, AstraZeneca, Boehringer-Ingelheim, A. Menarini Diagnostics, Eli Lilly, Medtronic, Novo Nordisk, and Roche, and research support from AstraZeneca, Boehringer-Ingelheim, Indigo Diabetes, and Novo Nordisk. SF has received grants from Astellas, Falk Pharma, Genfit, Gilead Sciences, GlympsBio, Janssens Pharmaceutica, Inventiva, Merck Sharp & Dome, Pfizer, and Roche. He has acted as consultant for Abbvie, Actelion, Aelin Therapeutics, Aligos Therapeutics, Allergan, Astellas, Astra Zeneca, Bayer, Boehringer Ingelheim, Bristol-Meyers Squibb, CSL Behring, Coherus, Echosens, Eisai, Enyo, Galapagos, Galmed, Genetech, Genfit, Gilead Sciences, Intercept, Inventiva, Janssens Pharmaceutica, Julius Clinical, Madrigal, Medimmune, Merck Sharp & Dome, NGM Bio, Novartis, Novo Nordisk, Promethera, and Roche. He has been lecturer for Abbvie, Allergan, Bayer, Eisai, Genfit, Gilead Sciences, Janssens Cilag, Intercept, Inventiva, Merck Sharp & Dome, Novo Nordisk, and Promethera. All other authors have nothing to disclose. Please refer to the accompanying ICMJE disclosure forms for further details.

Figures

None
Graphical abstract
Fig. 1
Fig. 1
Flowchart of study recruitment process showing exclusion criteria for the main and MRS cohort. Alcohol thresholds >three daily standardised alcoholic drinks for men, >two daily standardised alcoholic drinks for women; chronic liver disease: alpha-1 antitrypsin deficiency, viral hepatitis, Wilson’s disease, autoimmune hepatitis; steatogenic medication: corticosteroids, amiodarone, tamoxifen, methotrexate, nucleoside reverse transcriptase inhibitors; incorrect diagnosis of T1D: absence of autoimmune markers or absence of low/undetectable C-peptide. One person discontinued MRS because of acute claustrophobia. NIT, non-invasive test; MRS, magnetic resonance spectroscopy; T1D, type 1 diabetes.
Fig. 2
Fig. 2
Diagnostic flowchart to assess and monitor disease severity in the presence of type 1 diabetes combined with metabolic risk factors. Rescreening intervals at level 1 (negative ultrasound) and level 2 (non-elevated LSM) are derived from the European Association for the Study of the Liver NAFLD management guideline. ∗If screening is initially performed with combined ultrasound + VCTE imaging, proceeding immediately to level 2 is recommended. CAP, controlled attenuation parameter; LSM, liver stiffness measurement; MetS, metabolic syndrome; MRS, magnetic resonance spectroscopy; NAFLD, non-alcoholic fatty liver disease; NIT, non-invasive test; T1D, type 1 diabetes; VCTE, vibration controlled transient elastography.
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