Low Rates of MASLD Screening in Young Adults With Type 2 Diabetes: A Retrospective Cohort Study

ContextRegardless of age, metabolic dysfunction-associated steatotic liver disease (MASLD) occurs in 70% of adults with type 2 diabetes (T2D) and increases the risk of metabolic dysfunction-associated steatohepatitis (MASH), fibrosis, and cirrhosis. However, many studies focus on older adults.ObjectiveTo determine the frequency of screening for MASLD in young adults with T2D attending outpatient clinics.MethodsA retrospective cohort study on young adults (aged 18-44 years) with T2D who accessed care at a tertiary care center from January 1, 2018, to December 31, 2022. At-risk MASH was diagnosed with vibration-controlled transient elastography, magnetic resonance elastography, or liver biopsy.ResultsOf 6891 participants included, 16% (n = 1100) had a diagnosis of MASLD. Those with MASLD were more likely to have cardiometabolic risk factors (83% vs 72%, P < .001) and cardiovascular disease (22% vs 16%, P < .001). Only 12% of those with MASLD underwent further investigation (1.9% of the total cohort), which was associated with dyslipidemia (odds ratio [OR], 2.4; 95% CI, 1.5-3.8), ALT >40 U/L (OR, 2.1; 95% CI, 1.4-3.0), or the use of 3 or more diabetes medications (OR, 2.1; 95% CI, 1.5-3.1). In those with further workup, 38% had at-risk MASH. The fibrosis-4 index was elevated in 16% of those with MASLD and only 28% of those with confirmed at-risk MASH or worse.ConclusionScreening for MASLD in young adults with T2D is frequently missed. There is a lack of accurate noninvasive tools in this population. Increased awareness of screening young adults with T2D for at-risk MASH is urgently needed to prevent progression to cirrhosis.