Factores predictivos de MASLD en diabetes tipo 2: estudio de seguimiento de un año
DOI:
https://doi.org/10.5281/zenodo.10814344Palabras clave:
Enfermedad Hepática Esteatósica Asociada a Disfunción Metabólica, Diabetes Tipo 2, Alanina Aminotransferasa, Índice Esteatosis Hepática, Productos de Acumulación LipídicaResumen
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.
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