JHEP at a glance (March 2023)

Prevalence (%) Advanced fibrosis 10 12 14 16 18 8 6 4 2 0 20 Obese (n = 281) Non-obese (n = 209) Prevalence (%) Among 29 participants with cirrhosis, 2 had HCC and 1 had gallbladder adenocarcinoma 5.9% n = 29 14.0% n = 69 65.3% n = 322 NAFLD Advanced fibrosis Cirrhosis 70 60 50 40 30 20 10 0 Obesity significantly increased the risk of advanced fibrosis The prevalence of NAFLD, advanced fibrosis and cirrhosis were 65%, 14% and 6% respectively.Type 2 diabetes Age ≥50 years Prospectively recruited participants underwent a research examination with laboratory and clinical assessment to rule out other causes of liver disease.Fibroscan MRI Imaging assessment CAP MRE VCTE MRI-PDFF HighlightsIn prospectively recruited patients aged > -50 years with type 2 diabetes, the NAFLD prevalence was 65%.The prevalence of advanced fibrosis was 14% and that of cirrhosis was 6%.Obesity amplified the risk of NAFLD and advanced fibrosis.Three patients with cirrhosis were diagnosed with hepatobiliary malignancy.A lower FIB-4 cut-off point of 1 is required to maintain sensitivity >90% for advanced fibrosis in this population. Impact and implicationsNon-alcoholic fatty liver disease (NAFLD) is common in patients with type 2 diabetes (T2DM), however, there are limited prospective data characterizing the prevalence of advanced fibrosis and cirrhosis using the most accurate non-invasive biomarkers of liver fat and fibrosis.We show that 14% of older adults with T2DM have advanced fibrosis and 6% have cirrhosis, which places them at risk for liver failure and liver cancer.Accurate prevalence rates and comparative analysis regarding the diagnostic accuracy of non-invasive tests in this population will guide the optimal screening strategy and future cost-effectiveness analyses.These results will inform future Hepatology and Endocrinology practice guidelines regarding NAFLD screening programs in older adults with T2DM.