title: Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study.
abstract: Type 2 diabetes is an important risk factor for non-alcoholic fatty liver disease (NAFLD), but current guidelines provide conflicting recommendations on whether diabetic patients should be screened for NAFLD. We therefore studied the strategy of screening diabetic patients by FibroScan.
  
  
  
  Liver fat and fibrosis were assessed by controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) by FibroScan at a diabetic centre for patients from primary care and hospital clinics. Probe-specific LSM cut-offs were used to detect advanced fibrosis.
  
  
  
  Of 1918 patients examined, 1799 (93.8%) had valid CAP and 1884 (98.2%) had reliable LSM (1770 with the M probe and 114 with the XL probe). The proportion of patients with increased CAP and LSM was 72.8% (95% CI 70.7% to 74.8%) and 17.7% (95% CI 16.0% to 19.5%), respectively. By multivariable analysis, female gender, higher body mass index, triglycerides, fasting plasma glucose and alanine aminotransferase (ALT) and non-insulin use were associated with increased CAP. Longer duration of diabetes, higher body mass index, increased ALT and spot urine albumin:creatinine ratio and lower high-density lipoprotein-cholesterol were associated with increased LSM. Ninety-four patients (80% had increased LSM) underwent liver biopsy: 56% had steatohepatitis and 50% had F3-4 disease.
  
  
  
  Diabetic patients have a high prevalence of NAFLD and advanced fibrosis. Those with obesity and dyslipidaemia are at particularly high risk and may be the target for liver assessment. Our data support screening for NAFLD and/or advanced fibrosis in patients with type 2 diabetes.
authors: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Raymond
authors: R
authors: Kwok
authors: Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Kai Chow
authors: KC
authors: Choi
authors: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong State Key Laboratory in Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Grace Lai-Hung
authors: GL
authors: Wong
authors: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Yuying
authors: Y
authors: Zhang
authors: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong State Key Laboratory in Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Henry Lik-Yuen
authors: HL
authors: Chan
authors: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Andrea On-Yan
authors: AO
authors: Luk
authors: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong State Key Laboratory in Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Sally She-Ting
authors: SS
authors: Shu
authors: Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Anthony Wing-Hung
authors: AW
authors: Chan
authors: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Ming-Wai
authors: MW
authors: Yeung
authors: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Juliana Chung-Ngor
authors: JC
authors: Chan
authors: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Alice Pik-Shan
authors: AP
authors: Kong
authors: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong State Key Laboratory in Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Vincent Wai-Sun
authors: VW
authors: Wong
mesh_terms: D001706:Biopsy; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D054459:Elasticity Imaging Techniques / Q000295:instrumentation / Q000379:methods; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D008111:Liver Function Tests / Q000379:methods; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors