The prevalence and correlates of advanced fibrosis in patients with and without diabetes mellitus and metabolic dysfunction-associated steatotic liver disease: A cross-sectional study.

Background: The severity of liver fibrosis serves as a crucial prognostic indicator, reflecting liver-related and cardiovascular-related outcomes, as well as mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Type 2 diabetes mellitus (T2DM) is a major risk factor for developing metabolic dysfunction-associated steatohepatitis (MASH), and in patients with both T2DM and MASH, identifying those with advanced fibrosis is critical.

Methods: This cross-sectional study included 162 MASLD patients (47 with T2DM, 38 with prediabetes and 77 individuals without diabetes). The aim of this study was to determine the prevalence of advanced fibrosis in MASLD patients with and without DM and prediabetes, using a 2-step approach with fibrosis-4 index followed by liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE), and to evaluate the predictive cardiometabolic risk factors for the development of advanced fibrosis in these patients.

Results: Among patients with prediabetes and T2DM, 12.9 % were identified with F3 stage fibrosis, 6.5 % had F4 stage, totaling 19.4 % with advanced fibrosis or cirrhosis, assessed by VCTE. In contrast, among individuals without diabetes, 1.78 % was found to have F3 stage fibrosis, while 7.14 % had F4. In patients with T2DM or prediabetes, body mass index (BMI) was a significant predictor of advanced fibrosis (p = 0.02), with each unit increase in BMI linked to a 1.3-fold higher risk of advanced fibrosis and cirrhosis, and higher high-density lipoprotein cholesterol (HDL-C) levels were associated with lower odds of having F3 or F4 stage fibrosis (p = 0.04). In MASLD patients without diabetes, triglycerides (TGs) showed a significant positive correlation with liver stiffness (p = 0.04), male sex was significantly associated with a higher susceptibility to increased liver stiffness (p = 0.04), and males had 0.91 times the odds of developing advanced fibrosis and cirrhosis (p = 0.02). No significant correlations were observed between liver stiffness and age, sex, aspartate aminotransferase (AST), alanine aminotransferase (ALT), glucose levels, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), or TGs in patients with T2DM or prediabetes. In MASLD patients without diabetes, no significant correlations were found between liver stiffness and factors such as age, BMI, AST, ALT, TC, LDL-C, HDL-C, or glucose levels.

Conclusion: In conclusion, the prevalence of advanced fibrosis or cirrhosis in patients with both, MASLD and T2DM, is very high. In MASLD patients with T2DM or prediabetes, higher BMI and lower levels of HDL-C are significant predictors of advanced fibrosis or cirrhosis.