PT  - JOURNAL ARTICLE
AU  - Raymond Kwok
AU  - Kai Chow Choi
AU  - Grace Lai-Hung Wong
AU  - Yuying Zhang
AU  - Henry Lik-Yuen Chan
AU  - Andrea On-Yan Luk
AU  - Sally She-Ting Shu
AU  - Anthony Wing-Hung Chan
AU  - Ming-Wai Yeung
AU  - Juliana Chung-Ngor Chan
AU  - Alice Pik-Shan Kong
AU  - Vincent Wai-Sun Wong
TI  - Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study
AID  - 10.1136/gutjnl-2015-309265
DP  - 2016 Aug 01
TA  - Gut
PG  - 1359--1368
VI  - 65
IP  - 8
4099  - http://gut.bmj.com/content/65/8/1359.short
4100  - http://gut.bmj.com/content/65/8/1359.full
SO  - Gut2016 Aug 01; 65
AB  - 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.