<b>Objective:</b> Assess the prevalence of NAFLD and of
liver fibrosis associated with nonalcoholic steatohepatitis (NASH) in
unselected patients with T2DM.
<p><b>Research Design and
Methods:</b> 561 patients with T2DM (age: 60±11;
BMI: 33.4±6.2 kg/m<sup>2</sup>; HbA1c: 7.5±1.8%) attending primary care
or endocrinology outpatient clinics and unaware of having NAFLD. At the visit, volunteers were invited to be
screened by elastography for steatosis and fibrosis by CAP (≥274 dB/m) and LSM (≥7.0 kPa), respectively. Secondary causes of liver disease were ruled
out. Diagnostic panels for prediction of advanced fibrosis, such as APRI and
FIB-4, were also measured. A liver
biopsy was performed if results were suggestive of fibrosis.</p>
<p><b>Results:</b> The prevalence of steatosis was 70% and of fibrosis 21% (LSM≥7.0 kPa). Moderate fibrosis (F2: LSM≥8.2 kPa) was
present in 6% and severe fibrosis or cirrhosis (F3-4: LSM≥9.7 kPa) in 9%,
similar to that estimated by FIB-4 and APRI panels. Non-invasive testing was
consistent with liver biopsy results. Elevated
AST or ALT ≥40 U/L were present in a minority of patients with steatosis (8%
and 13%, respectively) or with liver fibrosis (18% and 28%, respectively). This
suggests that AST/ALT alone are insufficient as initial screening. However,
performance may be enhanced by imaging (e.g., transient elastography) and
plasma diagnostic panels (e.g., FIB-4, APRI).</p>
<p><b>Conclusions: </b>Moderate-to-advanced fibrosis (F≥2), an established risk
factor for cirrhosis and overall mortality, affects at least one-out-of-six (15%)
patients with T2DM. These results support the ADA guidelines to screen for clinically
significant fibrosis in patients with T2DM with steatosis or elevated ALT.</p>
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