The Journal of Clinical Endocrinology and Metabolism Journal Article

NAFLD Prevalence in Patients With Type 1 Diabetes

December 01, 2020

Marieke de Vries, Jan Westerink, Karin H A H Kaasjager, Harold W de Valk
The Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 12, December 2020, dgaa575
https://doi.org/10.1210/clinem/dgaa575

Abstract

Context

Nonalcoholic fatty liver disease (NAFLD) prevalence is high, especially in patients with obesity and type 2 diabetes, and is expected to rise steeply in the coming decades.

Objective

We estimated NAFLD prevalence in patients with type 1 diabetes and explored associated characteristics and outcomes.

Data Sources

We reviewed PubMed and Embase for studies on NAFLD and type 1 diabetes to March 2020. We screened references of included articles.

Study Selection

Two authors independently screened titles/abstracts. One author screened full text articles. NAFLD was defined as described in the individual studies: steatosis and/or fibrosis. Studies not reporting alternative causes of hepatic steatosis or defining NAFLD only as elevated liver enzymes, were excluded. Initially, 919 articles met the selection criteria.

Data Extraction

One researcher performed data extraction and risk of bias assessment using standardized tables.

Data Synthesis

We assessed pooled prevalence rates by meta-analysis using a random-effects model, subsequently exploring heterogeneity by subgroup-, meta-regression—, and sensitivity analysis. Twenty studies between 2009 and 2019 were included (n = 3901). Pooled NAFLD prevalence was 19.3% (95% CI, 12.3%-27.5%), increasing to 22.0% (95% CI, 13.9%—31.2%) in adults only. Pooled prevalence of ultrasound studies was high (27.1%, 95% CI, 18.7%—36.3%) compared to studies using magnetic resonance imaging (8.6%, 95% CI, 2.1%—18.6%), liver biopsy (19.3%, 95% CI, 10.0%—30.7%), or transient elastography (2.3%, 95% CI, 0.6%—4.8%).

Conclusion

NAFLD prevalence in patients with type 1 diabetes is considerable and is highly dependent on the specific diagnostic modality and NAFLD definition used. These data are helpful in directing actions to standardize NAFLD diagnosis, which will help defining contributing mechanisms and outcomes.