Metabolic dysfunction-associated steatotic liver disease (MASLD) is een veelvoorkomende leveraandoening die wordt gekenmerkt door vetophoping in de lever en wereldwijd bijna 30% van de bevolking treft. Mensen met type 2 diabetes hebben een verhoogd risico op MASLD, wat heeft geleid tot discussie over het nut van screening binnen deze groep. Voor mensen met type 1 diabetes is dit risico echter minder duidelijk. In deze Nederlandse studie is onderzocht of type 1 diabetes geassocieerd is met een verhoogd levervetgehalte, door deze groep te vergelijken met mensen met type 2 diabetes en met personen met een normale glucosestofwisseling.
Metabolic dysfunction-associated steatotic liver disease (MASLD), which is characterized by fat accumulation in the liver, is one of the most common liver diseases worldwide with a prevalence of almost 30%. People with type 2 diabetes are at an increased risk of MASLD, due to the overlap of risk factors such as obesity, poor dietary habits, sedentary lifestyle, and insulin resistance. This has fueled the debate about screening the type 2 diabetes population for MASLD. Whether people with type 1 diabetes are at increased risk of MASLD is unclear. Several studies investigating MASLD in type 1 diabetes reported highly varying prevalence data, in part related to the different methods used to estimate liver fat content including magnetic resonance imaging (MRI) and ultrasonography. Importantly, most studies lacked a well-matched control group to clarify whether type 1 diabetes is a risk factor for liver fat accumulation. Therefore, our aim was to compare liver fat content, estimated by MRI, in people with type 1 diabetes with that of two matched control groups, i.e. one with type 2 diabetes and the other with normal glucose metabolism.
We used data from the Maastricht Study, which is a population-based cohort study, that includes people aged 40-75 years, living in the southern part of Limburg in the Netherlands. We performed 1:2:2 matching based on BMI, sex, age and educational level for people with type 1 diabetes, type 2 diabetes and normal glucose metabolism, respectively. Liver fat content was assessed with MRI, validated by magnetic resonance spectroscopy. Multiple linear regression was performed to compare liver fat content between the three groups, adjusting for potential confounders such as cardiovascular risk factors, lifestyle factors and dietary factors. We also corrected for the use of insulin and for estimated glucose disposal rate (eGDR), which is a measure of insulin sensitivity.
A total number of 29 people with type 1 diabetes, 58 with type 2 diabetes and 58 with normal glucose metabolism were included in this study. Half of the study population was female and they had a mean age of 55 years and a slightly elevated BMI. HbA1c was higher in those with type 1 diabetes compared to people with type 2 diabetes and normal glucose metabolism. Hypertension was more evident in people with type 1 diabetes when compared to normal glucose metabolism population, but not when compared to people with type 2 diabetes. No differences were found in the quality of food intake (Dutch Healthy Diet Index) between the three groups. People with type 1 diabetes had a lower median liver fat content compared to people with type 2 diabetes (2.1% [IQR 1.1–3.3] vs 4.9% [IQR 2.2–9.6], p=0.001), but there were no differences in liver fat content compared to people with normal glucose metabolism (2.6% [IQR 1.8–3.8], p=0.064). Similarly, the prevalence of MASLD was lower in people with type 1 diabetes when compared to people with type 2 diabetes (6.9% vs 50%, p<0.001), but not when compared to those with normal glucose metabolism (13.8%, p=0.064 vs type 1 diabetes). After full adjustments, the difference in liver fat content between the two diabetes groups did not materially change, but attenuated after adjustment for eGDR and insulin treatment.
To conclude, the liver fat content of individuals with type 1 diabetes was about similar to that of people without diabetes and considerably lower than in those with type 2 diabetes. The difference of liver fat content between the two diabetes groups was independent of obesity, dietary factors and other confounders, but partially explained by insulin treatment and insulin sensitivity. Our findings that liver fat content is not elevated in people with type 1 diabetes argue against the need for screening of MASLD in the type 1 diabetes population, which alleviates both people with type 1 diabetes and clinicians from the extra burden of screening.
Auteurs
Nefeli M Dimitropoulou, Magdalena Beran, Simone J P M Eussen, Cassy F Dingena, Pieter C Dagnelie, Carla J H van der Kallen, Annemarie Koster, Marleen M J van Greevenbroek, Martijn C G J Brouwers, Miranda T Schram, Bastiaan E de Galan
