Prevalence and predictive features of metabolic dysfunction-associated steatotic liver disease in type 1 diabetes

Author:

Fuhri Snethlage Coco M1ORCID,Meijnikman Abraham S1,Mak Anne Linde1,Rampanelli Elena1,Voermans Bas12,Callender Cengiz A K1,de Groen Pleun1,Roep Bart O3,van Raalte Daniël H4,Knop Filip K5678ORCID,Holleboom Adriaan G1,Nieuwdorp Max1ORCID,Hanssen Nordin M J1

Affiliation:

1. Department of Vascular Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam , Amsterdam, AZ 1105 , The Netherlands

2. HORAIZON Technology B.V. Delft , GZ Delft 2625 , The Netherlands

3. Internal Medicine, Leids Universitair Medisch Centrum , Leiden, ZA 2333 , The Netherlands

4. Department of Endocrinology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam, AZ 1105 , The Netherlands

5. Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen , 2900 Hellerup , Denmark

6. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen , 2200 Copenhagen , Denmark

7. Steno Diabetes Center Copenhagen , Department of Clinical and Translational Research, 2730 Herlev , Denmark

8. Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen , 2200 Copenhagen , Denmark

Abstract

Abstract Aims/hypothesis The prevalence and severity of metabolic dysfunction-associated steatotic liver disease (MASLD) in type 1 diabetes remain unclear. Therefore, we investigated the prevalence and severity of MASLD in type 1 diabetes and assessed which clinical features are most important in predicting MASLD severity. Methods A total of 453 individuals with type 1 diabetes (41.6 ± 15.0 years, 64% female, body mass index [BMI] 25.4 ± 4.2 kg/m2, and HbA1c 55.6 ± 12 mmol/mol) underwent vibration-controlled transient elastography (VCTE), with a controlled attenuation parameter (CAP) score for steatosis (≥280.0 dB/m) and a liver stiffness measurement (LMS) for fibrosis (≥8.0 kPa). A machine learning Extra-Trees classification model was performed to assess the predictive power of the clinical features associated with type 1 diabetes with respect to steatosis and fibrosis. Results The prevalence of hepatic steatosis and fibrosis was 9.5% (95% CI, 6.8-12.2) and 3.5% (95% CI, 1.8-5.2). Higher LMS was associated with a longer duration of type 1 diabetes (median 30.5 [IQR 18.0-39.3] years vs 15.0 [IQR 6.0-27.0] years), and individuals were older, had a higher BMI (mean 27.8 ± 5.2 vs 25.3 ± 4.1 kg/m2), and a higher CAP score (mean 211.4 ± 51.7 dB/m vs 241.4 ± 75.6 dB/m). The most important predictive features of fibrosis were duration of type 1 diabetes, age, and systolic blood pressure, with a mean ± SD area under the curve of 0.73 ± 0.03. Conclusion Individuals with type 1 diabetes and high blood pressure, older age, higher BMI, and longer duration of disease could be considered at high-risk for developing MASLD.

Funder

Dutch Heart Foundation

Amsterdam UMC Fellowship

Dutch Gastroenterology Foundation

ZONMW-VICI

Dutch Diabetes Foundation

Dutch Kidney Foundation

TKI-PPP health-Holland

Publisher

Oxford University Press (OUP)

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