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

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

doi:10.1016/j.jhepr.2023.100753

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

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

Authors

Jonathan Mertens^{1

2

3}, Jonas Weyler^{2

3}, Eveline Dirinck^{1

2}, Luisa Vonghia^{2

3}, Wilhelmus J Kwanten^{2

3}, Laura Mortelmans³, Cedric Peleman^{2

3}, Shivani Chotkoe², Maarten Spinhoven⁴, Floris Vanhevel⁴, Luc F Van Gaal¹, Benedicte Y De Winter², Christophe E M De Block^{1

2}, Sven M Francque^{2

3}

Affiliations

¹ Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, Antwerp, Belgium.
² Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Faculty of Medicine & Health Sciences, Antwerp, Belgium.
³ Department of Gastroenterology & Hepatology, Antwerp University Hospital, Antwerp, Belgium.
⁴ Department of Radiology, Antwerp University Hospital, Antwerp, Belgium.

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.