Diagnosis and non-invasive assessment of MASLD in type 2 diabetes and obesity
Document Type
Article
Publication Date
6-1-2024
Abstract
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is currently the most common chronic liver disease and an important cause of cirrhosis and hepatocellular carcinoma. It is strongly associated with type 2 diabetes and obesity. Because of the huge number of patients at risk of MASLD, it is imperative to use non-invasive tests appropriately. Aims: To provide a narrative review on the performance and limitations of non-invasive tests, with a special emphasis on the impact of diabetes and obesity. Methods: We searched PubMed and Cochrane databases for articles published from 1990 to August 2023. Results: Abdominal ultrasonography remains the primary method to diagnose hepatic steatosis, while magnetic resonance imaging proton density fat fraction is currently the gold standard to quantify steatosis. Simple fibrosis scores such as the Fibrosis-4 index are well suited as initial assessment in primary care and non-hepatology settings to rule out advanced fibrosis and future risk of liver-related complications. However, because of its low positive predictive value, an abnormal test should be followed by specific blood (e.g. Enhanced Liver Fibrosis score) or imaging biomarkers (e.g. vibration-controlled transient elastography and magnetic resonance elastography) of fibrosis. Some non-invasive tests of fibrosis appear to be less accurate in patients with diabetes. Obesity also affects the performance of abdominal ultrasonography and transient elastography, whereas magnetic resonance imaging may not be feasible in some patients with severe obesity. Conclusions: This article highlights issues surrounding the clinical application of non-invasive tests for MASLD in patients with type 2 diabetes and obesity.
Keywords
Fatty liver-disease, machine learning-model, hepatic steatosis, nonalcoholic steatohepatitis, stiffness measurement, prospective derivation, fibrosis stage, United-States, XL probe, outcomes
Divisions
fac_med
Funders
Ministry of Education, Universities and Research (MIUR),Boehringer Ingelheim,Novo Nordisk Novo Nordisk Foundation,Roche Diagnostics,Inventiva,Gilead Sciences,Illuminatio Medical Technology Limited
Publication Title
Alimentary Pharmacology & Therapeutics
Volume
59
Issue
1, SI
Publisher
Wiley
Publisher Location
111 RIVER ST, HOBOKEN 07030-5774, NJ USA