A 2022 study by Ajmera and colleagues examined the prevalence of non-alcoholic fatty liver disease (NAFLD), advanced fibrosis, cirrhosis, and hepatocellular carcinoma (HCC) in older patients with type 2 diabetes (T2D). The strong association between T2D, NAFLD, and its progressive form non-alcoholic steatohepatitis (NASH) has been extensively underscored by recent literature. However, Ajmera and colleagues’ article stood out due to its use of non-invasive tools to screen for NAFLD in their target population. MRI-PDFF and transient elastography, two imaging noninvasive tools, were used for the assessment of steatosis and advanced fibrosis (F3), while blood-based FIB-4 scores were employed for the diagnosis of F3 and hepatocarcinomas.
The aim of this article was to question the results obtained using noninvasive methods in the aforementioned study.
The number of new NAFLD, cirrhosis, and/or HCC diagnoses delivered using noninvasive tools was not specified by the original article. Furthermore, while a low prevalence of NAFLD in older patients with T2D was originally reported, this may be due to reductions in steatosis degree associated with advanced fibrosis or cirrhosis, and/or the lack of MRI-PDFF use in all patients enrolled. Instead, transient elastography was conducted in all study participants using a high cut-off point which may have unintentionally excluded a proportion of patients with steatosis. Lastly, the newly proposed nomenclature for NAFLD, known as metabolic dysfunction-associated fatty liver disease (MAFLD), was not considered. Although the original study excluded patients with regular excessive alcohol consumption, the diagnosis of MAFLD includes this patient population. As such, future research must screen all patients with T2D for MAFLD, elderly or not, with or without alcohol consumption.