# Non-invasive risk stratification of metabolic dysfunction-associated steatotic liver disease and liver fibrosis in adults with type 1 diabetes

## TL;DR

This study identifies non-invasive tools to assess liver disease risk in adults with type 1 diabetes, highlighting the importance of early detection.

## Contribution

The study introduces non-invasive indices and elastography for risk stratification of MASLD and liver fibrosis in T1D patients.

## Key findings

- Non-invasive indices identified a higher proportion of individuals at increased risk for MASLD and fibrosis.
- Visceral fat correlated with HSI and FLI, and inversely with FIB-4.

## Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging comorbidity among patients with type 1 diabetes (T1D) that can potentially increase liver and cardiovascular outcomes. The aim of this study was to evaluate hepatic steatosis and to characterize non-invasive markers of MASLD and liver fibrosis risk in adults with T1D.

A cross-sectional, observational, single-center study was conducted from 2023–2024. The sample was adults with T1D at a tertiary hospital in Mexico. We recorded clinical, body-composition, and laboratory data. Hepatic steatosis was assessed by ultrasound, and non-invasive indices [Hepatic steatosis index (HSI), fatty liver index (FLI), and Fibrosis-4 (FIB-4)] and 2D shear-wave elastography (2D-SWE) were used to stratify the risk of MASLD and liver fibrosis. Bivariable and correlation analyses were performed.

Sixty-five adults were included (61.5% women; age 34 ± 10 years; T1D duration 20 [15–28] years; dyslipidemia 45%; overweight/obesity 51%; HbA1c 8.8 ± 2.0%. Ultrasound-compatible hepatic steatosis was observed in 25% (n=16). Noninvasive indices identified a higher proportion of individuals at increased risk for MASLD and fibrosis. HSI flagged 52% at risk and FLI 25% at high risk. Mean FIB-4 was 0.64 ± 0.36; 20% had fibrosis stage 2–3 and one stage 4–5. Elastography stiffness averaged 5.9 ± 0.69 kPa; 5% ≥7–8 kPa. MASLD was associated with higher stiffness, FIB-4, AST and lower platelets (all p<0.05; HSI p=0.06). Visceral fat correlated with HSI (r=0.525) and FLI (r=0.505) and inversely with FIB-4 (r=−0.261).

Non-invasive tools allow the identification of adults with T1D at increased risk for steatotic liver disease and fibrosis; however, these findings should be interpreted as risk stratification rather than definitive diagnosis.