Prevalence and predictive features of metabolic dysfunction-associated steatotic liver disease in type 1 diabetes

Aims/hypothesis The prevalence and severity of metabolic dysfunction-associated steatotic liver disease (MASLD) in type 1 diabetes remain unclear. Therefore, we investigated the prevalence and severity of MASLD in type 1 diabetes and assessed which clinical features are most important in predicting MASLD severity.Methods A total of 453 individuals with type 1 diabetes (41.6 +/- 15.0 years, 64% female, body mass index [BMI] 25.4 +/- 4.2 kg/m2, and HbA1c 55.6 +/- 12 mmol/mol) underwent vibration-controlled transient elastography (VCTE), with a controlled attenuation parameter (CAP) score for steatosis (>= 280.0 dB/m) and a liver stiffness measurement (LMS) for fibrosis (>= 8.0 kPa). A machine learning Extra-Trees classification model was performed to assess the predictive power of the clinical features associated with type 1 diabetes with respect to steatosis and fibrosis.Results The prevalence of hepatic steatosis and fibrosis was 9.5% (95% CI, 6.8-12.2) and 3.5% (95% CI, 1.8-5.2). Higher LMS was associated with a longer duration of type 1 diabetes (median 30.5 [IQR 18.0-39.3] years vs 15.0 [IQR 6.0-27.0] years), and individuals were older, had a higher BMI (mean 27.8 +/- 5.2 vs 25.3 +/- 4.1 kg/m2), and a higher CAP score (mean 211.4 +/- 51.7 dB/m vs 241.4 +/- 75.6 dB/m). The most important predictive features of fibrosis were duration of type 1 diabetes, age, and systolic blood pressure, with a mean +/- SD area under the curve of 0.73 +/- 0.03.Conclusion Individuals with type 1 diabetes and high blood pressure, older age, higher BMI, and longer duration of disease could be considered at high-risk for developing MASLD. Graphical Abstract