ISSN: 0443-511
e-ISSN: 2448-5667
Usuario/a
Idioma
Herramientas del artículo
Envíe este artículo por correo electrónico (Inicie sesión)
Enviar un correo electrónico al autor/a (Inicie sesión)
Tamaño de fuente

Open Journal Systems

Factores predictivos de MASLD en diabetes tipo 2: estudio de seguimiento de un año / Predictive factors for MASLD in type 2 diabetes: 1 year follow-up study

Niels H. Wacher, Rita A. Gómez-Díaz, Adriana L. Valdez-González, Ximena Duque-López, Segundo Morán-Villota, Rafael Mondragón-González, Miguel Cruz-López, Víctor H. Borja-Aburto

Resumen


Resumen

Introducción: se ha propuesto la nomenclatura actual de enfermedad hepática esteatósica asociada a disfunción metabólica (MASLD) como término general para abarcar las diversas etiologías de la esteatosis e incluir la presencia de al menos 1 de 5 factores de riesgo cardiometabólico.

Objetivo: evaluar los factores predictores de incidencia de MASLD en pacientes con diabetes tipo 2 (DT2) a un año de seguimiento en primer nivel de atención.

Material y métodos: cohorte prospectiva que incluyó 5143 pacientes con DT2 (≤ 15 años de diagnóstico) de unidades de medicina familiar del IMSS en Ciudad de México y el área metropolitana. Se tomaron al inicio y a un año de seguimiento: medidas antropométricas, HbA1c, microalbuminuria, creatinina, perfil de lípidos, aspartato aminotransferasa, alanino aminotransferasa (ALT); se calculó el HSI (Índice de esteatosis hepático) y LAP (productos de acumulación lipídica). Se consideraron como MASLD los casos con la presencia de ALT anormal.

Resultados: al inicio, el 28.2% (n = 1449) presentaron MASLD. Los índices HSI y LAP fueron mayores en los casos con MASLD. La edad y tiempo de evolución de DT2 mostró asociación negativa con MASLD y positiva con índice de masa corporal, perímetro de cintura (PCi) y HbA1c. De los casos con MASLD al inicio, el 38% (n = 452) revirtieron y persistieron con esta alteración 712 (61.2%) al año de seguimiento. Los odds ratio (OR) para MASLD fueron de 1.86 y 1.88 para HbA1c y PCi, respectivamente.

Conclusiones: la combinación de HSI, LAP y el tamizaje con HbA1c y PCi son de utilidad para identificar MASLD en pacientes con DT2.

 

Abstract

Background: It has been proposed the current nomenclature for metabolic dysfunction-associated steatotic liver disease (MASLD) as a general term to encompass the various etiologies of steatosis and to include the presence of at least 1 of 5 cardiometabolic risk factors.

Objective: To evaluate the predictors of the incidence of MASLD in patients with type 2 diabetes (T2D) in primary care at a one-year follow-up.

Material and methods: Prospective cohort study including patients (n = 5143) with ≤ 15 years from diagnosis of T2D, treated at primary care units in Mexico City and metropolitan area. At baseline and at one-year follow-up were measured: anthropometry, HbA1c, microalbuminuria, creatinine, lipid profile and hepatic markers aspartate aminotransferase and alanine aminotransferase (ALT). Hepatic Steatosis Index (HSI) and Lipidic Accumulation Product (LAP) were calculated. MASLD was considered as cases with abnormal ALT.

Results: At baseline, 1449 (28.2%) patients presented MASLD. The HSI and LAP indices were higher in MASLD. Age at diagnosis and time of exposure to T2D were inversely associated with MASLD, and directly proportional to body mass index, waist circumference (WC) and HbA1c. Of the cases with MASLD at baseline, 452 (38.8%) reverted to normal and 712 (61.2%) persisted after follow-up. ORs for MASLD were 1.86 and 1.88 for HbA1c and WC, respectively.

Conclusions: The combination of HSI, LAP and screening with HbA1c and WC are useful to identify MASLD in patients with T2D.


Palabras clave


Enfermedad Hepática Esteatósica Asociada a Disfunción Metabólica; Diabetes Tipo 2; Alanina Aminotransferasa; Índice Esteatosis Hepática; Productos de Acumulación Lipídica / Metabolic Dysfunction Associated Steatotic Liver Disease; Type 2 Diabetes

Texto completo:

PDF

Referencias


Wai-Sun Wong V, Ekstedt M, Lai-Hung Wong G, et al. Changing epidemiology, global trends and implications for outcomes of NAFLD. J Hepatol. 2023:S0168-8278(23)00324-0.

Arab JP, Dirchwolf M, Álvares-da-Silva MR, et al. Latin American Association for the study of the liver (ALEH) practice guidance for the diagnosis and treatment of non-alcoholic fatty liver disease. Ann Hepatol. 2020;19(6):674-90.

Denova-Gutiérrez E, Lara-Castor L, Hernández-Alcaraz C, et al. Prevalence and predictors of elevated liver enzyme levels in Mexico: The Mexican National Health and Nutrition Survey, 2016. Ann Hepatol. 2021;26:100562.

Eslam M, Sanyal AJ, George J. MAFLD: a consensus-driven proposed nomenclature for metabolic associated fatty liver disease. Gastroenterology. 2020;158(7):1999-2014.

Chen L. From metabolic dysfunction-associated fatty liver disease to metabolic dysfunction-associated steatotic liver disease: Controversy and consensus. World J Hepatol. 2023;15(12):1253-7.

Leung PB, Davis AM, Kumar S. Diagnosis and Management of Nonalcoholic Fatty Liver Disease. JAMA. 2023. doi: 10.1001/jama.2023.17935.

Lin S, Huang J, Wang M, et al. Comparison of MAFLD and NAFLD diagnostic criteria in real world. Liver Int. 2020;40(9):2082-9.

Okada A, Yamada G, Kimura T, et al. Diagnostic ability using fatty liver and metabolic markers for metabolic-associated fatty liver disease stratified by metabolic/glycemic abnormalities. J Diabetes Investig. 2023;14(3):463-78.

Lee JH, Kim D, Kim HJ, et al. Hepatic steatosis index: a simple screening tool reflecting nonalcoholic fatty liver disease. Dig Liver Dis. 2010;42:503-8.

Bedogni G, Kahn HS, Bellentani S, et al. A simple index of lipid over accumulation is a good marker of liver steatosis. BMC Gastroenterolology. 2010;25:10:98. https://doi.org/10.1186/1471-230X-10-98.

Dai H, Wang W, Chen R, et al. Lipid accumulation product is a powerful tool to predict non-alcoholic fatty liver disease in Chinese adults. Nutr Metab (Lond). 2017;14:49. https://doi.org/10.1186/s12986-017-0206-2.

Foschi FG, Conti F, Domenicali M, et al., Bagnacavallo Study Group. External validation of surrogate indices of fatty liver in the general population: the Bagnacavallo Study. J Clin Med. 2021;10(3):520. https://doi.org/10.3390/jcm10030520.

Özcabı B, Demirhan S, Akyol M, et al. Lipid accumulation product is a predictor of nonalcoholic fatty liver disease in childhood obesity. Korean J Pediatr. 2019;62(12):450-5.

Zhang Y, Li B, Liu N, et al. Evaluation of different anthropometric indicators for screening for nonalcoholic fatty liver disease in elderly individuals. Int J Endocrinol. 2021;2021:6678755. https://doi.org/10.1155/2021/6678755.

Saokaew S, Kositamongkol C, Charatcharoenwitthaya P, et al. Comparison of noninvasive scoring systems for the prediction of nonalcoholic fatty liver disease in metabolic syndrome patients. Medicine (Baltimore). 2020;99(50):e23619.

Saokaew S, Kositamongkol C, Charatcharoenwitthaya P, et al. Comparison of noninvasive scoring systems for the prediction of nonalcoholic fatty liver disease in metabolic syndrome patients. Medicine (Baltimore). 2020;99(50):e23619.

American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S19-S40.

Schindhelm RK, Diamant M, Dekker JM, et al. Alanine aminotransferase as a marker of non-alcoholic fatty liver disease in relation to type 2 diabetes mellitus and cardiovascular disease. Diabetes Metab Res Rev. 2006;22:437-43.

Verma S, Jensen D, Hart J, et al. Predictive value of ALT levels for non- alcoholic steatohepatitis (NASH) and advanced fibrosis in nonalcoholic fatty liver disease (NAFLD). Liver Int. 2013;33,1398-405.

Peng H, Pan L, Ran S, et al. Prediction of MAFLD and NAFLD using different screening indexes: A cross-sectional study in U.S. adults. Front Endocrinol (Lausanne). 2023;14:1083032.

Lonardo A, Nascimbeni F, Ballestri S, et al. Sex differences in nonalcoholic fatty liver disease: State of the art and identification of research gaps. Hepatology. 2019;70(4):1457-69.

Williamson RM, Price JF, Glancy S, et al; Edinburgh Type 2 Diabetes Study Investigators. Prevalence of and risk factors for hepatic steatosis and nonalcoholic fatty liver disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study. Diabetes Care. 2011;34:1139-44.

Miranda Manrique G. Metabolic parameters in patients with steatosis non-alcoholic liver and controlled diabetes type 2 versus uncontrolled diabetes type 2. Rev Gastroenterol Peru. 2016:36:336-9.

European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388-402.

Tang A, Rabasa-Lhoret R, Castel H, et al. Effects of insulin glargine and liraglutide therapy on liver fat as measured by magnetic resonance in patients with type 2 diabetes: A randomized trial. Diabetes Care. 2015;38:1339-46.

Sehatpour F, Salehi A, Molavi Vardanjani H, et al. Upper normal limit of serum alanine aminotransferase and its association with metabolic risk factors in Pars Cohort Study. Middle East J Dig Dis. 2020;12(1):19-26.

Alsabaani AA, Mahfouz AA, Awadalla NJ, et al. Non-alcoholic fatty liver disease among type-2 diabetes mellitus patients in Abha City, South Western Saudi Arabia. Int J Environ Res Public Health. 2018;15(11):2521.

Suresh S, Rajanbabu B, Mavila Veetil V, et al. A study on the altered glycemic and lipid parameters and prevalence of insulin resistance in nonalcoholic fatty liver disease. J Family Med Prim Care. 2018;7:93-7.

Zheng KI, Fan JG, Shi JP, et al. From NAFLD to MAFLD: a "redefining" moment for fatty liver disease. Chin Med J (Engl). 2020;133(19):2271-3.

Alexander M, Loomis AK, Fairburn-Beech J, et al. Real-world data reveal a diagnostic gap in non-alcoholic fatty liver disease. BMC Med. 2018;16(1):130. https://doi.org/10.1186/s12916-018-1103-x.

Yamamura S, Eslam M, Kawaguchi T, et al. MAFLD identifies patients with significant hepatic fibrosis better than NAFLD. Liver Int. 2020;40(12):3018-30.

Ciardullo S, Sala I, Perseghin G. Screening strategies for nonalcoholic fatty liver disease in type 2 diabetes: insights from NHANES 2005-2016. Diabetes Res Clin Pract. 2020;167:108358. https://doi.org/10.1016/j.diabres.2020.108358.

Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: Evaluation of abnormal liver chemistries. Am J Gastroenterol. 2017;112:18-35.

Binet Q, Loumaye A, Hermans MP, et al. A cross-sectional real-life study of the prevalence, severity, and determinants of metabolic dysfunctionassociated fatty liver disease in type 2 diabetes patients. J Clin Transl Hepatol. 2023;11(6):1377-86. doi: 10.14218/JCTH.2023.00117.




DOI: https://doi.org/10.24875/10.5281/zenodo.10814344

Enlaces refback

  • No hay ningún enlace refback.