Prevalence, risk factors and diagnostic accuracy of non-invasive tests for NAFLD in people with type 1 diabetes
Jonathan Mertens,
Jonas Weyler,
Eveline Dirinck,
Luisa Vonghia,
Wilhelmus J. Kwanten,
Laura Mortelmans,
Cedric Peleman,
Shivani Chotkoe,
Maarten Spinhoven,
Floris Vanhevel,
Luc F. Van Gaal,
Benedicte Y. De Winter,
Christophe E.M. De Block,
Sven M. Francque
Affiliations
Jonathan Mertens
Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, Antwerp, Belgium; Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Faculty of Medicine & Health Sciences, Antwerp, Belgium; Department of Gastroenterology & Hepatology, Antwerp University Hospital, Antwerp, Belgium
Jonas Weyler
Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Faculty of Medicine & Health Sciences, Antwerp, Belgium; Department of Gastroenterology & Hepatology, Antwerp University Hospital, Antwerp, Belgium
Eveline Dirinck
Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, Antwerp, Belgium; Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Faculty of Medicine & Health Sciences, Antwerp, Belgium
Luisa Vonghia
Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Faculty of Medicine & Health Sciences, Antwerp, Belgium; Department of Gastroenterology & Hepatology, Antwerp University Hospital, Antwerp, Belgium
Wilhelmus J. Kwanten
Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Faculty of Medicine & Health Sciences, Antwerp, Belgium; Department of Gastroenterology & Hepatology, Antwerp University Hospital, Antwerp, Belgium
Laura Mortelmans
Department of Gastroenterology & Hepatology, Antwerp University Hospital, Antwerp, Belgium
Cedric Peleman
Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Faculty of Medicine & Health Sciences, Antwerp, Belgium; Department of Gastroenterology & Hepatology, Antwerp University Hospital, Antwerp, Belgium
Shivani Chotkoe
Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Faculty of Medicine & Health Sciences, Antwerp, Belgium
Maarten Spinhoven
Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
Floris Vanhevel
Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
Luc F. Van Gaal
Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, Antwerp, Belgium
Benedicte Y. De Winter
Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Faculty of Medicine & Health Sciences, Antwerp, Belgium
Christophe E.M. De Block
Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, Antwerp, Belgium; Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Faculty of Medicine & Health Sciences, Antwerp, Belgium
Sven M. Francque
Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Faculty of Medicine & Health Sciences, Antwerp, Belgium; Department of Gastroenterology & Hepatology, Antwerp University Hospital, Antwerp, Belgium; Corresponding author. Address: Antwerp University Hospital, Drie eikenstraat 655, B-2650 Edegem, Belgium; Tel.: +32 3 821 45 72, fax: +32 3 821 44 78.
Background & Aims: The epidemiology of non-alcoholic fatty liver disease (NAFLD) in people with type 1 diabetes (T1D) is not yet elucidated. This study aimed to assess the diagnostic accuracy of non-invasive tests for NAFLD, to investigate the prevalence and severity of NAFLD, and to search for factors contributing to NAFLD in people with T1D. Methods: In this prospective cohort study, we consecutively screened 530 adults with T1D from a tertiary care hospital, using ultrasound (US), vibration-controlled transient elastography equipped with liver stiffness measurement (LSM) and controlled attenuation parameter, and the fatty liver index. Magnetic resonance spectroscopy (MRS) was performed in a representative subgroup of 132 individuals to validate the diagnostic accuracy of the non-invasive tests. Results: Based on MRS as reference standard, US identified individuals with NAFLD with an AUROC of 0.98 (95% CI 0.95–1.00, sensitivity: 1.00, specificity: 0.96). The controlled attenuation parameter was also accurate with an AUROC of 0.85 (95% CI 0.77–0.93). Youden cut-off was ≥270 dB/m (sensitivity: 0.90, specificity: 0.74). The fatty liver index yielded a similar AUROC of 0.83 (95% CI 0.74–0.91), but the conventional cut-off used to rule in (≥60) had low sensitivity and specificity (0.62, 0.78). The prevalence of NAFLD in the overall cohort was 16.2% based on US. Metabolic syndrome was associated with NAFLD (OR: 2.35 [1.08–5.12], p = 0.031). The overall prevalence of LSM ≥8.0 kPa indicating significant fibrosis was 3.8%, but reached 13.2% in people with NAFLD. Conclusions: NAFLD prevalence in individuals with T1D is 16.2%, with approximately one in 10 featuring elevated LSM. US-based screening could be considered in people with T1D and metabolic syndrome. Impact and Implications: We aimed to report on the prevalence, disease severity, and risk factors of NAFLD in type 1 diabetes (T1D), while also tackling which non-invasive test for NAFLD is the most accurate. We found that ultrasound is the best test to diagnose NAFLD. NAFLD prevalence is 16.2%, and is associated with metabolic syndrome and BMI. Elevated liver stiffness indicating fibrosis is overall not prevalent in people with T1D (3.8%), but it reaches 13.2% in those with T1D and NAFLD.
