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The utility of noninvasive scores in assessing the prevalence of nonalcoholic fatty liver disease and advanced fibrosis in type 1 diabetic patients

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Abstract

Goals

The aim of our study is to assess the prevalence of nonalcoholic fatty liver disease (NAFLD) and advanced hepatic fibrosis in patients with type 1 diabetes (T1D) using simple noninvasive scores.

Background

There is paucity of data on the prevalence of NAFLD in T1D. Moreover, T1D could be a risk factor for advanced disease in NAFLD patients.

Study

Using ICD-9 codes, all patients with the diagnosis of T1D were reviewed and a retrospective chart analysis was carried out on 23,314 patients between the ages of 18 and 80. To predict the prevalence of NAFLD, we calculated the hepatic steatosis index (HSI). To estimate the prevalence of advanced fibrosis, NAFLD fibrosis score (NFS), FIB-4 index, AST to platelet ratio index (APRI), and AST/ALT ratio were calculated.

Results

Of the 4899 patients included in the analysis, 86.9% were Caucasian and 67% were above normal weight limit. NAFLD based on HSI > 36 was present in 71.3% of patients. Advanced fibrosis was present in 20.3% based on NFS > 0.676, 6.7% based on FIB-4 > 2.67, 2.1% based on APRI > 1.5, and 22.1% based on AST/ALT > 1.4%, indicating a high risk of developing cirrhosis and end-stage liver disease.

Conclusion

In this large cohort of patients with T1DM, we detected a high prevalence of hepatic steatosis and advanced fibrosis using noninvasive scores. These scores are easy and inexpensive tools to screen for NAFLD and advanced fibrosis, although the significant variability of the percentage of advanced fibrosis using these scores indicates the need for further validation in diabetic populations.

Clinical trial registration number

CCF-16-018.

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Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Center for Human Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Amandeep Singh

  2. Center for Value-based Care Research, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Phuc Le

  3. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Rocio Lopez

  4. Texas Liver Institute, San Antonio, TX, USA

    Naim Alkhouri

  5. Department of Hospital Medicine, M8-Annex, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Amandeep Singh

Authors
  1. Amandeep Singh
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Correspondence to Amandeep Singh.

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Conflict of interest

A.S.: No conflict of interest and nothing to disclose. P.L.: No conflict of interest and nothing to disclose. R.L.: No conflict of interest and nothing to disclose. N.A.: No conflict of interest and nothing to disclose.

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Singh, A., Le, P., Lopez, R. et al. The utility of noninvasive scores in assessing the prevalence of nonalcoholic fatty liver disease and advanced fibrosis in type 1 diabetic patients. Hepatol Int 12, 37–43 (2018). https://doi.org/10.1007/s12072-017-9840-z

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  • DOI: https://doi.org/10.1007/s12072-017-9840-z

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