High Prevalence of Fatty Liver in Bangladeshi Adolescents and Young Adults with Type 2 Diabetes: Key Predictors and Screening Recommendations

Kishore Kumar Shil,1 Mashfiqul Hasan,2 Nusrat Sultana,2 Sayad Bin Abdus Salam,2 Syeda Nazlee Mostafa,3 Muhammad Abul Hasanat2 1Department of Endocrinology, Khulna Medical College Hospital, Khulna, Bangladesh; 2Department of Endocrinology, Bangladesh Medical University, Dhaka, Bangladesh; 3Department of Radiology and Imaging, Bangladesh Medical University, Dhaka, BangladeshCorrespondence: Kishore Kumar Shil, Department of Endocrinology, Khulna Medical College Hospital, Khulna, Bangladesh, Tel +8801723512712, Email [email protected]: Obesity and insulin resistance are the key pathogenic factors for both metabolic dysfunction-associated steatotic liver disease (MASLD) and type-2 diabetes (T2DM), and their rising prevalence is driving an increase in MASLD cases.Objective: To assess the presence of fatty liver disease by ultrasonography (USG) and to find out its predictors in newly diagnosed young-onset T2DM.Methods: This cross-sectional study enrolled 137 newly diagnosed adolescents and young adult T2DM subjects (aged 10– 34 years) by non-probability purposive sampling at a tertiary hospital in Bangladesh. Individuals with a history of alcoholism, pregnancy, infections, endocrinopathies, genetic disorders, or drugs that can cause fatty liver were excluded. Fatty liver was assessed by ultrasonography. C-peptide, anti-GAD65, and anti-IA2 antibodies were measured by chemiluminescent immunoassay, and anti-ZnT8 antibodies by ELISA.Results: Among 137 newly diagnosed adolescents and young adult T2DM patients, 92 (68.1%) had fatty liver on ultrasonography— 58 (63%) with grade 1 and 34 (37%) with grade 2. Most were overweight/obese (67.2%), had central obesity (88.3%), and reported low physical activity (68.6%). Fatty liver was significantly associated with older age, higher BMI, WHR, and a positive family history of diabetes. On multivariate analysis, age (OR 1.14, 95% CI 1.04– 1.25, p=0.004), positive family history of DM (OR 3.21, 95% CI 1.29– 8.22, p=0.012), acanthosis nigricans (OR: 5.05, 95% CI 1.59– 16.04, p=0.006), and fasting C-peptide levels (OR 1.46, 95% CI 1.10– 1.92; p = 0.007) were significant predictors of fatty liver.Conclusion: Fatty liver is highly prevalent in young-onset T2DM at diagnosis. Age, a positive family history of diabetes, acanthosis nigricans, and elevated fasting C-peptide levels are strong predictors. Routine use of ultrasonography may facilitate early detection and management of liver disease in this population.Keywords: fatty liver, risk factors, young onset T2DM