Screening strategies for nonalcoholic fatty liver disease in type 2 diabetes: Insights from NHANES 2005–2016. (September 2020)

• Record Type: Journal Article
• Authors: Ciardullo, Stefano; Sala, Isabella; Perseghin, Gianluca
• Is Part Of: Diabetes research and clinical practice. Volume 167(2020)
• Publication Date: 2020-09
• Subjects: NAFLD -- T2DM -- Liver fibrosis -- Guidelines -- Referral; NAFLD Nonalcoholic Fatty Liver Disease -- T2DM Type 2 Diabetes Mellitus -- NHANES National Health and Nutrition Examination Survey -- AASLD American Association for the Study of Liver Diseases -- EASL European Association for the Study of the Liver -- EASD European Association for the Study of Diabetes -- EASO European Association for the Study of Obesity -- FLI Fatty Liver Index -- HSI Hepatic Steatosis Index -- FIB-4 Fibrosis-4 -- NFS NAFLD Fibrosis Score -- HFS Hepamet Fibrosis Score -- CVD Cardiovascular Disease -- CKD Chronic Kidney Disease -- UACR Urine Albumin to Creatinine Ratio; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2020.108358
• Languages: English
• ISSNs: 0168-8227

Abstract

Abstract: Aim: Nonalcoholic fatty liver disease (NAFLD) is prevalent in patients with type 2 diabetes mellitus (T2DM), but controversy exists on whether to screen and how to manage these patients in clinical practice. Here, we estimate the number of patients with T2DM and NAFLD in the United States that should be evaluated for advanced liver fibrosis according to proposed screening strategies. Methods: In this cross-sectional analysis of 2940 adult patients with T2DM (projected to 15.3 million) from the 2005–2016 National Health and Nutrition Examination Survey (NHANES) we applied validated noninvasive scores of liver steatosis and fibrosis to estimate the number of referrals to hepatologists. We followed two different approaches: (1) the flow-chart from the European Association for the Study of the Liver (EASL), Diabetes (EASD) and Obesity (EASO) guidelines; (2) a strategy recently proposed in patients with T2DM aimed at excluding advanced liver fibrosis with a negative predictive value of 100%. Results: NAFLD (based on fatty liver index) was present in 78% of patients (projected to 11.9 million). According to the EASL-EASD-EASO guidelines 37.2–48.5% of patients (projected to 5.7–7.4 million) should be referred to experts, depending on the specific biomarker of fibrosis used. The second strategy, which is based sequentially on aspartate aminotransferase and Fibrosis-4 was able to exclude advanced fibrosis in 67.0% of patients. Conclusions: Screening strategies based on noninvasive scores are able to exclude advanced liver fibrosis in 50–67% of patients with T2DM. Novel biomarkers or combination of tests may be necessary to reduce the need for liver biopsy and related bleeding episodes in the remaining 33–50%.