Endocrine Abstracts

Introduction: Non-alcoholic fatty liver disease (NAFLD) is an underdiagnosed complication in Type 2 Diabetes (T2D). This condition can evolve into steatohepatitis (NASH) and more severe entities such as liver cirrhosis and hepatic failure, being currently the first cause for liver transplantation in our environment. In Andalusian T2D patients, the exact prevalence is still unknown. Our aim is to assess the prevalence of NAFLD/NASH in a cohort of these patients.

Material and Methods: Descriptive prospective study, conducted at the Endocrinology Department of the Virgen del Rocio University Hospital between 10th May 2018 and 31st December 2019. After favourable evaluation from the local ethics committee, all T2D patients admitted to this department were offered enrolment, excluding those with pre-existing liver disease or alcohol abuse, as well as those below 18 years old. We used as screening tools the Hepatic Steatosis Index (HSI), Fibrosis-4 (FIB-4) and NAFLD Fibrosis Score (NFS), whose results were afterwards compared with transient elastography (FibroScan) obtained from the same patient. Quantitative variables were expressed as median [Interquartile range] while qualitative ones were recorded as n patients (percentage). This study was possible thanks to a supporting grant from Menarini Spain.

Results: Total sample n = 105, 45 females (F) and 60 males (M), aged 60.0 years [53.5–68.5] (M 59 [54–68], F 63 [53–69]). BMI 34.21 Kg/m² [31.22–43.26] (M 33.76 [31.24–42.99], F 34.67 [30.54–43.26]). T2D duration: 9 years [4–16] (M 10.00 [5.25–19.00], F 9 [2.5–12.5]); HbA1c 7.30% [6.45–8.35] (M 7.40 [6.60–8.93], F 7.10 [6.20–7.80]). HSI: positive (>36) in n = 96 (94.12%), median 46.55 [42.51–57.17]; FIB-4 risk of fibrosis: low risk (<1.3) n = 79 (76.7%), moderate (2.66–1.30) n = 22 (21.36%), very high (>2.67) n = 2 (1.94%). NFS risk of fibrosis: low (<–1.455) n = 6 (9.37%), moderate (–1.455 to 0.676) n = 42 (65.63%), High/Very High (>0.676) n = 16 (25.00%). Liver Elastography: No fibrosis/mild fibrosis F0-F1 (<7.5 kPa) n = 52 (73.24%), Fibrosis F2 (7.5–9.5 kPa, moderate) n = 12 (16.90%), Fibrosis F3 (9.5–14 kPa, severe) n = 4 (5.63%), Cirrhosis F4 (> 14 kPa) n = 3 (4.23%).

Conclusions: In our series, up to 26.76% of asymptomatic patients show moderate to severe hepatic fibrosis and are at risk of developing cirrhosis. FIB-4 seems to be more precise than NFS in estimating liver fibrosis degree. Our results, if confirmed in other populations, should made physicians aware of the importance of NASH in T2D and prompt the early screening and follow-up of this condition.