Diabetes is a strong predictor of worse outcomes in nonalcoholic fatty liver disease (NAFLD), such as cirrhosis, CVD, and overall mortality. However, its true prevalence in clinical practice, and the role of obesity contributing to fibrosis, remain unclear. To this end, we recruited 759 patients without known NAFLD (35% with T2DM; age: 56 ± 11 years; BMI: 30.8 ± 6.5 kg/m2; female 59 %; ethnicity: Caucasian 75%, AA 14%, other 11%) attending outpatient endocrine/primary care clinics. We measured: 1) Routine laboratories; 2) Liver fat (CAP score ≥ 274 dB/m) and fibrosis (liver stiffness measurement or LSM) by elastography. The prevalence of NAFLD in T2DM was 68% vs. 44% in those without T2DM (p<0.05). Comparing patients with vs. without T2DM, the presence of any liver fibrosis (LSM ≥7 kPa or F≥1) was 20% vs. 6%, of clinically significant fibrosis (LSM ≥8 kPa [moderate-to-severe] = F≥2) was 12% vs. 4%, and advanced fibrosis (LSM ≥ 9.7 kPa = F3/F4) was 7% vs. 1%, respectively (all p<0.05). Obesity in T2DM promoted a much higher prevalence of steatosis (80% vs. 47% in T2DM without obesity) and of moderate-to-severe fibrosis (17% vs. 3%, respectively, both p<0.05). In people without T2DM, obesity also played a major role regarding steatosis (obese: 66 % vs. non-obese: 28%) and moderate-to-severe fibrosis (F≥2: 8% vs. 1%, respectively; both p<0.05). Worse glycemic control in people with T2DM (A1c ≥7.0% vs. <7.0%) led to a higher prevalence of steatosis (75% vs. 62%) and of fibrosis (24% vs 18%; both p<0.05). In multiple regression analysis, with a 95% CI, obesity in T2DM was the most significant risk factor for steatosis (OR 2.8, 1.9-4.2) and fibrosis (OR 3.4, 2.1-5.3). Conclusion: People with T2DM are at a very high risk of hepatic steatosis and severe fibrosis. Obesity is a major risk factor for worse disease, even in the absence of diabetes. These findings strongly support recent ADA recommendations to screen people with T2DM and obesity and cardiometabolic risk factors for moderate-to-severe fibrosis.


E.Valdez saenz: None. D.Barb: None. A.Sharma: None. K.Cusi: Consultant; Poxel SA, Altimmune, Arrowhead Pharmaceuticals, Inc., AstraZeneca, 89bio, Inc., Bristol-Myers Squibb Company, Lilly, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Medscape, Myovant, Novo Nordisk, ProSciento, Quest Diagnostics, Sagimet, Sonic Incytes, Terns, Research Support; Echosens, Inventiva, LabCorp, Zydus. E.Godinez leiva: None. R.Lomonaco: None. S.Kalavalapalli: None. S.A.Marangi: None. M.A.Gonzalez: None. A.Ortiz rocha: None. X.Chi: None. M.J.Gurka: None.


National Institutes of Health (R01120331-01A1)

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