OR19-04 MASLD - a Forgotten Complication in Young Adults with Type 2 Diabetes

Abstract Disclosure: C. deCrecy: None. D. Calin: None. Q. Yang: None. R. Yin: None. A. Sharma: None. Introduction and Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD) occurs in up to 70% of people with type 2 diabetes (T2D) regardless of age. Unfortunately, the fibrosis-4 index (FIB-4) underestimates the risk of MASLD in young adults. We therefore hypothesized that young adults with T2D are infrequently screened for MASLD. Methods: Young adults (18-44 yrs old) with T2D (ICD codes 250.xx and E11.xx) who accessed care at a tertiary center from January 1, 2018, to December 31, 2022, were identified. Charts with associated codes for MASLD (K74.00, K74.01, K74.02, K74.60, K74.69, K75.81, K76.0) and vibration-controlled transient elastography (VCTE; CPT 91200) were reviewed in detail to confirm the diagnosis of MASLD. “At risk” metabolic dysfunction-associated steatohepatitis (MASH) was defined as a liver stiffness measurement ≥ 8.0 kPa on VCTE or ≥2.97 kPa on magnetic resonance imaging (MRE), and/or a liver biopsy confirming steatohepatitis with fibrosis. Results: Of the 8507 young adults identified, 1301 were excluded due to other types of diabetes; 7206 were included in the final analysis. Young adults with T2D (age 36 ± 7 yrs) were more likely to be female (60%) and had a high prevalence of cardiometabolic risk factors: 74% had obesity, 58% hypertension (HTN), and 42% dyslipidemia. Of the 1220 (17%) young adults with a MASLD diagnosis code, only 14% (n=167; 2% of the entire cohort) underwent further diagnostic work-up: 134 with VCTE, 3 with MRE, and 71 with liver biopsy; 41 underwent more than one modality). “At risk” MASH or worse was confirmed in 54% (91/167). Gastroenterology (68%) and endocrinology (18%) ordered most of the work up for MASLD. The only clinical variables associated with further work-up were elevated transaminase concentrations (p<0.01). An alternate cause for liver disease was found in 5% with an associated diagnosis for MASLD (37% of those who underwent further workup). Young adults with MASLD were more likely to be female (62% women vs 38% men, p=0.05), have obesity (84% vs 72%, p<0.01), HTN (71% vs 56%, p<0.01), dyslipidemia (59% vs 38%, p<0.01), and ischemic heart disease (14% vs 10%, p<0.01). There were no differences in glycemic control (HbA1c 7.3% ± 1.8 vs 7.4% ± 2.4, NS) or prevalence of chronic kidney disease (10% vs 11 %, NS). Despite higher transaminase levels in the MASLD group [AST 21 (IQR 16-36) vs 17 (IQR 14-25) IU/L and ALT 23 (IQR 17-39) vs 18 (IQR 14-26) IU/L, both p<0.01)], FIB-4 was no different (0.6 ± 0.3 vs 0.7 ± 0.7, NS). Only 4 young adults with confirmed “at risk” MASH or worse had a FIB-4 ≥1.3. Conclusion: Screening for MASLD in young adults with T2D is frequently missed. The lack of accurate non-invasive tools may be prohibiting early identification of “at risk” MASH in young adults with T2D. Increased awareness to screen young adults with T2D for “at risk” MASH is urgently needed to prevent progression to cirrhosis. Presentation: Sunday, July 13, 2025