Background: Worldwide NAFLD prevalence is approximately 25% in the general population and 56% in patients with type 2 diabetes mellitus (T2DM). The relationship between NAFLD and type 1 diabetes mellitus (T1DM) is less clear, with widely varying prevalence estimates (0 to 50%), dependent on the study population, NAFLD definition and diagnostic method. Data on assessment of hepatic steatosis (HS) as well as fibrosis stage with transient elastography (TE) as single diagnostic method are lacking.
Methods: We assessed NAFLD using TE in an unselected group of adult patients with T1DM. Patients attending the outpatient clinic were eligible if they did not have any known secondary cause of liver disease including excessive alcohol consumption. We calculated a required group size of 150 patients. All patients underwent TE (M- or XL-probe when applicable). NAFLD was defined as isolated HS and/or fibrosis/cirrhosis. HS was assessed by controlled attenuation parameter: S0 (no HS) to S3 (severe HS). Fibrosis stage was assessed by liver stiffness measurement: F0/F1 (no fibrosis) to F4 (cirrhosis). Potential associated factors of NAFLD were explored using a multivariate logistic regression model, stepwise including predefined covariates.
Results: We prospectively enrolled 150 consecutive subjects with T1DM (mean age 46 ± 13 years, female 46%). The prevalence of NAFLD was 34% (51/150). Fifty-one patients (34%) had HS (S1 n=21, S2 n=4, S3 n=26). Six patients (4%) had HS with fibrosis/cirrhosis (F2 n=2, F3 n=2, F4 n=2). After stepwise adjustment for age and BMI, waist circumference remained statistically significantly associated with the presence of NAFLD (OR 1.16, 95% CI 1.02.-1.32).
Conclusions: Overall NAFLD prevalence in patients with T1DM is slightly increased at 34% compared to the general population. The prevalence of NAFLD in patients with T1DM is associated with visceral adiposity.
M. de Vries: None. J. Westerink: None. K. Kaasjager: None. H.W. de Valk: None.
