Hepatic steatosis with significant fibrosis is associated with preclinical carotid atherosclerosis in patients with type 1 diabetes

Abstract

Aims: Evaluate the association between metabolic dysfunction-associated steatotic liver disease (MASLD) scores and preclinical atherosclerosis in type 1 diabetes (T1D).

Methods: Cross-sectional study in T1D individuals without cardiovascular disease (CVD) with ≥ 1 of the following: ≥40 years, diabetic kidney disease, and/or ≥ 10 years of T1D duration with CVD risk factors. MASLD was estimated with Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), and FIB-4. Three groups were established: no steatosis, steatosis, and steatosis + fibrosis. Preclinical atherosclerosis was evaluated by carotid ultrasonography.

Results: We included 679 individuals (49.8 % women, age 47.8 ± 10.7 years, T1D duration 26.9 ± 10.8 years, body mass index 26.1 ± 4.3 kg/m²). The prevalence of steatosis and steatosis + fibrosis was 45.2 % and 8.4 % by HIS and 13.7 % and 5.1 %, respectively, by FLI. Carotid plaques were correlated with steatosis/fibrosis markers (HSI + FIB-4: no steatosis, 34.6 %; steatosis, 38.1 %; steatosis + fibrosis, 64.9 %; FLI + FIB-4: 38.8 %, 50 %, and 65 %, respectively; p < 0.01 for both). In multivariate models adjusted for conventional and T1D-specific risk factors, only the steatosis + fibrosis combination by HSI was associated with atherosclerosis (OR 1.97 [1.02-3.82]) and OR 1.97 [1.01-3.84] for plaque presence and ≥ 2 plaques, respectively.

Conclusion: Hepatic fibrosis markers are associated with increased carotid atherosclerosis in T1D. Non-invasive MASLD scores could help identify T1D patients at higher CVD risk.

Keywords: Carotid atherosclerosis; Carotid ultrasound; Liver fibrosis; MASLD; Type 1 Diabetes.