Prevalence of high-risk metabolic dysfunction-associated fatty liver disease (MASH) according to the FAST® index in a group of diabetic patients

Introduction and Objectives

Diabetes is a high-risk condition for the progression of metabolic-associated fatty liver disease (MASLD). The FAST index combines the FibroScan® and AST to predict the risk of high-risk metabolic dysfunction-associated steatohepatitis (MASH). Objective: determine the proportion of diabetic patients at high risk of MASH according to the FAST index.

Materials and Patients

Observational, cross-sectional study to estimate prevalence. Diabetic patients who agreed to undergo FibroScan® and liver biochemistry profile were included. The FAST® index was calculated (<0.35 no risk; 0.35 to 0.67 indeterminate; ≥ 0.67 high-risk NASH). Descriptive statistics were used, and a correlation matrix was performed using Pearson's test, with a p value < 0.05 considered significant.

Results

298 patients were evaluated, 195 (64.5%) women, mean age 55.6±10.8 years, of whom 284 (95.3%) agreed to undergo FibroScan® study, 109 (38.4%) presented steatosis: S1 in 34 (12%), S2 in 33 (11.6%) and S3 in 42 (14.8%). 155 (56.4%) had fibrosis: F1 in 42 (14.8%), F2 in 40 (14.1%), F3 in 26 (9.2%) and F4 in 47 (16.5%). 261 (87.6%) patients had recent determination of aminotransferases; according to the FAST® index: without risk= 200 (76.6%), indeterminate= 31 (11.9%), and with high risk= 30 (11.5%). There was a strongly positive correlation between a higher FAST index and a higher probability of having a higher degree of fibrosis (r=0.702, p<0.0001). The correlation matrix is shown in Table 1

Conclusions

The prevalence of MASH is considerable in patients with diabetes; the factors that determine this risk in this population are not yet clear. FAST® appears to be a non-invasive tool for making decisions regarding MASH.

Ethical Statement: This study was conducted following the principles and ethical standards of our institution in accordance with the Declaration of Helsinki.

Declaration of Interests: None.

Funding: This project was financed through the “Young Researchers Scholarship” awarded to Dr. Kevin Sergio Vázquez Hernández by Grupo Medifarma S.A. de C.V.

Table 1.

Correlation Matrix to Determine the Correlation between FAST® Score and Clinical Characteristics in a Cohort of Diabetic Patients

Covariate	Correlation Coefficient	P
Sex (women)	0.161	0.009*
Adherence to Treatment	-0.162	0.009*
Steatosis Stage	0.115	0.063
Fibrosis Stage	0.702	0.000*
Metabolic Syndrome	0.056	0.369
Smoking	-0.022	0.719
HbA1c (±7)	0.124	.056

*The correlation is significant with p<0.05