Liver and Bile
Hepatology. 2022;76(5):1409–22
Risk of liver-related events by age and diabetes duration in patients with diabetes and non-alcoholic fatty liver disease
Background and aims: Several guidelines recommend screening for non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes (T2D). The aim of this study was to determine if there is a threshold of age and duration of T2D for liver-related event (LRE) development to guide screening strategies.
Approach and results: The authors conducted a territory-wide retrospective cohort study of adult patients with NAFLD and T2D diagnosed between 2000 and 2014 in Hong Kong to allow for at least 5 years of follow-up. The primary end point was LREs, defined as a composite of hepatocellular carcinoma and cirrhotic complications. This study included 7028 patients with NAFLD with T2D (mean age, 56.1 ± 13.3 years; 3363 male [47.9%]). During a follow-up of 77,308 person-years, there was a threshold effect with 1.1%, 4.9%, and 94.0% of patients developing LREs at the age of < 40, 40–50, and ≥ 50 years, respectively. Similarly, 3.1%, 5.1%, and 91.8% of patients developed cirrhosis at the age of < 40, 40–50, and ≥ 50 years, respectively. In contrast, LREs increased linearly with diabetes duration, with no difference in the annual incidence rate between the first 10 years of T2D diagnosis and subsequent years (0.06% vs. 0.10%; p = 0.136). On multivariable analysis, baseline age ≥ 50 years (adjusted hazard ratio [aHR] = 2.01) and cirrhosis (aHR = 3.12) were the strongest risk factors associated with LREs. Substitution of cirrhosis with the aspartate aminotransferase-to-platelet ratio index or the Fibrosis-4 index yielded similar results.
Conclusions: Age rather than duration of type 2 diabetes (T2D) predicts liver-related events in patients with non-alcoholic fatty liver disease (NAFLD) and T2D. It is reasonable to screen patients with NAFLD and T2D for advanced liver disease starting at 50 years of age.