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Cited by 136Liver Disease Diagnosis and TreatmentChronic Kidney Disease and DiabetesDiabetes, Cardiovascular Risks, and Lipoproteins

High prevalence of NASH and advanced fibrosis in type 2 diabetes: a prospective study of 330 outpatients undergoing liver biopsies for elevated ALT, using a low threshold

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Castera, Laurent, Laouenan, Cédric, Vallet-Pichard, Anaïs, Vidal-Trécan, Tiphaine, Manchon, Pauline, Paradis, Valérie, Roulot, Dominique, Gault, Nathalie +23 more·2023·Diabetes Care
DOI 10.2337/dc22-2048
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Abstract

OBJECTIVE: Most people with type 2 diabetes (T2DM) and nonalcoholic steatohepatitis (NASH) or advanced fibrosis (AF) remain undiagnosed, resulting in missed opportunities for early intervention. This multicenter, prospective study assessed the yield of using routinely available data to identify these patients. RESEARCH DESIGN AND METHODS: A total of 713 outpatients with T2DM, screened in four diabetology clinics for nonalcoholic fatty liver disease according to American Diabetes Association criteria, were referred to hepatologists for further work-up (Fibrosis-4 and vibration-controlled transient elastography [VCTE]). A liver biopsy was proposed when ALT levels were persistently >20 IU/L in female patients or >30 IU/L in male patients, in the absence of other liver disease. RESULTS: Liver biopsies were performed in 360 patients and considered adequate for reading after central review for 330 specimens (median patient age, 59 years; male patients, 63%; median BMI and HbA1c values, 32 and 7.5%, respectively). Prevalence of NASH, AF, and cirrhosis were 58%, 38%, and 10%, respectively. Liver lesions were independently associated with the components of metabolic syndrome but not with the micro- and macrovascular complications of T2DM. Models based on routinely available data with or without VCTE had good accuracy to predict AF (respectively: area under the receiver operating characteristic curve [AUROC], 0.84 and 0.77; and correctly classified 59% and 45%) and NASH (respectively: AUROC, 0.82 and 0.81; 44% and 42%). CONCLUSIONS: Despite the use of a low ALT threshold, prevalence of NASH (58%) or AF (38%) was high. Routinely available data had a high yield in identifying patients with T2DM with AF and/or NASH requiring further liver assessment.

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  • T2D is associated with an increased risk of liver fibrosis assessed by VCTE and/or MR-based techniques, or with a prevalence of advanced (F3-F4) fibrosis on histology in biopsy-proven MASLD/MASH ranging from 30 to 38%.

    “T2D is associated with an increased risk of liver fi brosis, assessed by vibration-controlled transient elastography (VCTE) and/or magnetic resonance (MR)-based techniques, 51 or with the prevalence of advanced (F3-F4) fi brosis on histology in biopsy-proven MASLD/MASH, ranging from 30 to 38%.”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [52]

    The Histopathologic Assessment section defines advanced fibrosis as biopsy-staged F3–F4, and the Conclusions report a 38% prevalence in this study's selected T2D outpatients with NAFLD. The paper also discusses VCTE, but the cited passages do not establish the 30% lower end or MR-based assessment; the 38% estimate should not be generalized beyond the study population. Page numbers are unavailable in our copy. (LLM, conf=0.87)

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Authors
Castera, L., Laouenan, C., Vallet-Pichard, A., Vidal-Trécan, T., Manchon, P., Paradis, V., Roulot, D., Gault, N., Boitard, C., Terris, B., Bihan, H., Julla, J.-B., Radu, A., Poynard, T., Brzustowsky, A., Larger, E., Czernichow, S., Pol, S., Bedossa, P., Valla, D., Gautier, J.-F., The QUID-NASH investigators, Junot, C., Van Beers, B., Boitard, C., de Préville, N., Durand Zaleski, I., Rautou, P.-E., Dioguardi, M., Vilgrain, V., & Riveline, J.-P.
Affiliations
  • 1Université Paris Cité, UMR1149 (CRI), INSERM, Paris, France
  • Inserm (FR)
  • 5Service d’hépatologie, Assistance Publique–Hôpitaux de Paris, Groupe hospitalier Cochin, Paris, France
  • Assistance Publique – Hôpitaux de Paris (FR)
  • 10Université Paris Cité, Institut Cochin, U1016, INSERM, Paris, France
  • Université Sorbonne Paris Nord (FR)
  • Centre National de la Recherche Scientifique (FR)
  • 20Délégation régionale Paris 5/Paris 7, Paris, France
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2023-04-12
Volume
46
Issue
7
Pages
1354-1362
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc22-2048
OpenAlex
W4365138277
Cited by
136
References
38
Citations by year
2026: 28 · 2025: 46 · 2024: 51 · 2023: 11
FWCI
27.15
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/journals/pages/license (vor)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Funders
Agence Nationale de la Recherche (ANR-17-T171105J-RHUS-0009)
Topics
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
nonalcoholic steatohepatitis, advanced liver fibrosis, type 2 diabetes, non-alcoholic fatty liver disease, liver biopsy, vibration-controlled transient elastography, FIB-4, metabolic syndrome, liver cirrhosis, prevalence, risk prediction model, outpatients
MeSH terms
Biopsy, Diabetes Mellitus, Type 2, Female, Fibrosis, Humans, Liver, Liver Cirrhosis, Male, Middle Aged, Outpatients, Prospective Studies, Prevalence, Non-alcoholic Fatty Liver Disease

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