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Open Access 03-07-2025 | Type 2 Diabetes | Original Research
Prevalence of Hepatic Steatosis and Fibrosis in Asian Indian Individuals with Type 2 Diabetes
Authors: Khandhulwa Chandramouli Bhuvanesswar, Brijendra Kumar Srivastava, Anandakumar Amutha, Varun Damle, Aswin Krishna, Prasanna Kumar Gupta, Phillips Routray, Dhanasekaran Killivalavan, Saravanan Jebarani, Ulagamathesan Venkatesan, Rosette James Chakkalakal, Shalimar, Janardanan Subramonia Kumar, Duvvur Nageshwar Reddy, Anand V. Kulkarni, Ranjit Unnikrishnan, Ranjit Mohan Anjana, Krishna Govindarajapuram Seshadri, Viswanathan Mohan
Published in: Diabetes Therapy
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Introduction
Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with diabetes mellitus, representing a significant health concern owing to its potential progression to cirrhosis of the liver. We aim to determine the prevalence of MASLD using transient elastography (TE by FibroScanR by Echosens, Paris) in individuals with type 2 diabetes (T2D).
Methods
The retrospective data (between 2020 and 2024) of 1070 individuals with T2D (who reported no alcohol intake) who underwent FibroScan assessment at two diabetes clinics were included for analysis. Steatosis was classified using controlled attenuation parameters (CAP) (dB/m) as: S0 (< 238 dB/m), S1 (238–260 dB/m), S2 (260–290 dB/m), and S3 (290–400 dB/m). Liver stiffness measurement (LSM)(kPa) was graded as: F0–F1 (no significant fibrosis, ≤ 8.1 kPa), F2 (≥ 8.2–9.6 kPa), F3 (≥ 9.7–13.5 kPa), and F4 (≥ 13.6 kPa). Fibrosis 4 score (FIB-4), nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS), and aspartate transaminase (AST)-to-platelet ratio index (APRI) were calculated for LSM.
Results
The mean age, duration of diabetes, and body mass index (BMI) were 55.1 ± 11.5 yrs, 11.8 ± 8.6 years, and 27.9 ± 4.8 kg/m2, respectively. S0, S1, S2, and S3 steatosis were present in 24.4%, 16.0%, 20.1%, and 39.5%, respectively. Fibrosis was absent (F0–F1) in 71.4%, while F2 was present in 9.9%, F3 in 9.3%, and F4 in 9.4%. Any degree of steatosis and fibrosis were present in 75.6% and 28.6%, respectively, and were more frequently observed in women than in men. Among the risk scores, the sensitivity for detecting fibrosis was 67.2% for FIB-4, 84.1% for NFS, and 40.9% for APRI, although the latter had higher specificity (84.4%).
Conclusions
More than 75.6% of individuals with T2D have evidence of hepatic steatosis and 28.6% have fibrosis, as indicated by TE (FibroScan). FIB-4, NFS, and APRI have variable sensitivity and specificity for detecting hepatic fibrosis in Asian Indian individuals with T2D.
