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Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study
  1. Raymond Kwok1,2,
  2. Kai Chow Choi3,
  3. Grace Lai-Hung Wong1,2,4,
  4. Yuying Zhang1,
  5. Henry Lik-Yuen Chan1,2,4,
  6. Andrea On-Yan Luk1,
  7. Sally She-Ting Shu1,2,4,
  8. Anthony Wing-Hung Chan5,
  9. Ming-Wai Yeung1,
  10. Juliana Chung-Ngor Chan1,
  11. Alice Pik-Shan Kong1,
  12. Vincent Wai-Sun Wong1,2,4
  1. 1Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
  2. 2Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
  3. 3Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong
  4. 4State Key Laboratory in Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
  5. 5Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong
  1. Correspondence to Dr Vincent Wong, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F, Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong; wongv{at}cuhk.edu.hk

Abstract

Objective Type 2 diabetes is an important risk factor for non-alcoholic fatty liver disease (NAFLD), but current guidelines provide conflicting recommendations on whether diabetic patients should be screened for NAFLD. We therefore studied the strategy of screening diabetic patients by FibroScan.

Design Liver fat and fibrosis were assessed by controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) by FibroScan at a diabetic centre for patients from primary care and hospital clinics. Probe-specific LSM cut-offs were used to detect advanced fibrosis.

Results Of 1918 patients examined, 1799 (93.8%) had valid CAP and 1884 (98.2%) had reliable LSM (1770 with the M probe and 114 with the XL probe). The proportion of patients with increased CAP and LSM was 72.8% (95% CI 70.7% to 74.8%) and 17.7% (95% CI 16.0% to 19.5%), respectively. By multivariable analysis, female gender, higher body mass index, triglycerides, fasting plasma glucose and alanine aminotransferase (ALT) and non-insulin use were associated with increased CAP. Longer duration of diabetes, higher body mass index, increased ALT and spot urine albumin:creatinine ratio and lower high-density lipoprotein-cholesterol were associated with increased LSM. Ninety-four patients (80% had increased LSM) underwent liver biopsy: 56% had steatohepatitis and 50% had F3-4 disease.

Conclusions Diabetic patients have a high prevalence of NAFLD and advanced fibrosis. Those with obesity and dyslipidaemia are at particularly high risk and may be the target for liver assessment. Our data support screening for NAFLD and/or advanced fibrosis in patients with type 2 diabetes.

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