Prevalence of Nonalcoholic Fatty Liver Disease in Type 1 Diabetes Mellitus and Utility of Noninvasive Tests

OBJECTIVES: Ultrasound often misses mild steatosis and does not assess fibrosis, a key mortality predictor in nonalcoholic fatty liver disease (NAFLD). Due to the invasiveness of biopsy and the impracticality of magnetic resonance imaging, we evaluated transient elastography (TE) and noninvasive tests (NITs) in type 1 Diabetes Mellitus. METHODOLOGY: In 85 patients, NAFLD was defined using a controlled attenuation parameter (CAP) ≥248 dB/m or a Liver Stiffness Measurement (LSM) ≥7 kPa with TE, which served as the reference standard. Serum chemerin, aspartate aminotransferase/Alanine aminotransferase (AST/ALT) ratio, AST to Platelet Ratio Index, FIB-4 score, and the Enhanced Liver Fibrosis (ELF) score were assessed. RESULTS: The prevalence of NAFLD by TE was 23 (27%), with steatosis in 18 (21.4%) and fibrosis in 8 (9.5%). Lean NAFLD was seen in 11 patients, with 6 having fibrosis. Patients with NAFLD had higher weight, waist circumference (WC), waist-hip ratio, and systolic blood pressure. The AST/ALT ratio and chemerin performed poorly for steatosis detection, and ELF scores were not significantly elevated in fibrosis. FIB-4 was significantly higher in fibrosis (0.69) than in those without (0.40). A cut-off of 0.5 predicted fibrosis, with 75% sensitivity, 31.6% specificity and a negative predictive value of 86.2% for excluding fibrosis. LSM correlated with the FIB-4 score. Insulin resistance measured by estimated glucose disposal rate showed no difference across body mass index categories or in Metabolic Syndrome. CONCLUSION: NAFLD was observed in nearly one-quarter of individuals. NITs, including a lower FIB-4 score, could aid in screening this high-risk population.