Aim

We examined whether metabolic dysfunction-associated steatotic liver disease (MASLD) with or without significant fibrosis (assessed by validated non-invasive biomarkers) was associated with an increased risk of prevalent chronic kidney disease (CKD) or diabetic retinopathy in people with type 1 diabetes mellitus (T1DM).

Methods

We performed a retrospective multicenter cross-sectional study involving 1,409 adult outpatients with T1DM, in whom hepatic steatosis index (HSI) and fibrosis (FIB)-4 index were calculated for non-invasively detecting hepatic steatosis (defined by HSI > 36), with or without coexisting significant fibrosis (FIB-4 index ≥ 1.3 or < 1.3). CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m² or urine albumin/creatinine ratio ≥ 3.0 mg/mmol. The presence of diabetic retinopathy was also recorded in all participants.

Results

Patients with MASLD and significant fibrosis (n = 93) had a remarkably higher prevalence of CKD and diabetic retinopathy than their counterparts with MASLD without fibrosis (n = 578) and those without steatosis (n = 738). After adjustment for sex, diabetes duration, hemoglobin A1c, hypertension, and use of antihypertensive or lipid-lowering medications, patients with SLD and significant fibrosis had a higher risk of prevalent CKD (adjusted-odds ratio 1.76, 95 % confidence interval 1.05–2.96) than those without steatosis. Patients with MASLD without fibrosis had a higher risk of prevalent retinopathy (adjusted-odds ratio 1.49, 95 % CI 1.13–1.46) than those without steatosis.

Conclusion

This is the largest cross-sectional study showing that MASLD with and without coexisting significant fibrosis was associated, independently of potential confounders, with an increased risk of prevalent CKD and retinopathy in adults with T1DM.

中文翻译：

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MASLD、肝脂肪变性和纤维化与成人 1 型糖尿病患者慢性肾病和视网膜病变的患病率相关

目的

我们研究了伴有或不伴有明显纤维化的代谢功能障碍相关脂肪肝病 (MASLD)（通过经过验证的非侵入性生物标志物评估）是否与 1 型糖尿病患者患慢性肾病 (CKD) 或糖尿病视网膜病变的风险增加相关糖尿病（T1DM）。

方法

我们进行了一项回顾性多中心横断面研究，涉及 1,409 名成人 T1DM 门诊患者，计算了肝脂肪变性指数 (HSI) 和纤维化 (FIB)-4 指数，用于无创检测肝脂肪变性（定义为 HSI > 36），其中或没有并存显着的纤维化（FIB-4指数≥1.3或<1.3）。CKD 定义为估计肾小球滤过率 (eGFR) < 60 mL/min/1.73 m ²或尿白蛋白/肌酐比值≥ 3.0 mg/mmol。所有参与者还记录了糖尿病视网膜病变的存在。

结果

患有 MASLD 和显着纤维化的患者 ( n  = 93) 的 CKD 和糖尿病视网膜病变患病率明显高于患有无纤维化的 MASLD 患者 ( n  = 578) 和没有脂肪变性的患者 ( n  = 738)。调整性别、糖尿病病程、血红蛋白 A1c、高血压以及使用抗高血压或降脂药物后，患有 SLD 和显着纤维化的患者罹患 CKD 的风险较高（调整后比值比 1.76，95% 置信区间 1.05–2.96） ）比那些没有脂肪变性的人。与无脂肪变性的患者相比，无纤维化的 MASLD 患者发生视网膜病变的风险更高（调整后比值比 1.49，95% CI 1.13-1.46）。

结论

这是最大的横断面研究，表明无论是否存在共存显着纤维化，MASLD 与 T1DM 成人中流行 CKD 和视网膜病变的风险增加相关，与潜在的混杂因素无关。