Prevalence, Incidence and Characteristics of NAFLD/NASH in Type 1 Diabetes Mellitus (NAFLDIA1)
Prevalence, Incidence and Characteristics of NAFLD/NASH in Type 1 Diabetes Mellitus Obtained Via a Non-invasive Screening Protocol
Nonalcoholic fatty liver disease (NAFLD) is a condition characterized by intrahepatic fat accumulation. It is closely related to insulin resistance. To date, it remains unclear whether NAFLD is common in patients with type 1 diabetes or if NAFLD translates into an increased health burden in this population. Screening for NAFLD is challenging due to the limitations of non-invasive diagnostic tools.
Liver biopsy remains the gold standard but is not suited for routine screening or clinical studies. Therefore, there is a great demand for accurate non-invasive screening tools that can not only diagnose but also stage NAFLD. This study aims to generate a large cohort of thoroughly characterized type 1 diabetes patients screened for NAFLD using multiple non-invasive tools including MRI, ultrasound, controlled attenuation parameter, and score panels. We aim to generate a biobank to promote a research collaboration network in the field of non-invasive diagnosis of NAFLD.
A secondary endpoint is to investigate the potential correlation between the presence of NAFLD and the occurrence of micro-or macrovascular complications in patients with diabetes.
調査の概要
状態
詳細な説明
This study aims to characterize and follow a thoroughly characterized cohort of adult type 1 diabetes patients free from secondary liver disease due to excessive alcohol usage, viral hepatitis, alfa-1 antitrypsin deficiency, Wilson's disease or steatogenic or hepatotoxic drug use.
The investigators will screen for NAFLD and fibrosis using multiple non-invasive techniques including
- ultrasound
- controlled attenuation parameter
- fatty liver index
- human steatosis index
- transient elastography
- FIB-4
- NAFLD fibrosis score
- NASH algorithm based on multiple parameters
Subjects will be screened for microvascular and microvascular complications with:
- ECG
- microfilament examination
- 24hour urine collection for microalbuminuria
- serum kidney test (creatinine, eGFR)
- fundoscopy
- peripheral arterial pulsation palpation
The investigators will subsequently thoroughly characterize various metabolic and anthropometric parameters and document any microvascular or macrovascular complications.
The patients will be annually rescreened for both NAFLD-related as cardiovascular variables. Therefore this study will assess the correlation between NAFLD, cardiovascular risk, and type 1 diabetes in a prospective manner.
研究の種類
入学 (予想される)
連絡先と場所
研究連絡先
- 名前:Jonathan Mertens, M.D.
- 電話番号:+328217304
- メール:jonathan.mertens@uza.be
研究連絡先のバックアップ
- 名前:Rie Braspenning, nurse
- メール:rie.braspenning@uza.be
研究場所
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Antwerp
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Edegem、Antwerp、ベルギー、2650
- 募集
- Antwerp University Hospital
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コンタクト:
- Jonathan Mertens, M.D.
- 電話番号:+328217304
- メール:jonathan.mertens@uza.be
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-
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
サンプリング方法
調査対象母集団
説明
Inclusion Criteria:
- Type 1 diabetes
- Adult age
- Informed consent given
Exclusion Criteria:
- Secondary liver disease
- Excess alcohol usage
- Pregnancy
- Use of steatogenic medication
- Active cancer or oncological treatment
- History of organ transplantation
研究計画
研究はどのように設計されていますか?
デザインの詳細
コホートと介入
グループ/コホート |
介入・治療 |
---|---|
NAFLD + type 1 diabetes
type 1 diabetes patient with NAFLD on screening
|
ultrasound to check for NAFLD according to Saverymuttu criteria
elastography to compare liver stiffness indices
CAP is a non-invasive additive on Fibroscan (trademark) which can quantify hepatic steatosis
the FLI is a score panel designed to screen for NAFLD
the FIB-4 is a score panel designed to screen for significant fibrosis
the NFS is a score panel designed to screen for significant fibrosis
|
noNAFLD + type 1 diabetes
type 1 diabetes patient without NAFLD on screening
|
ultrasound to check for NAFLD according to Saverymuttu criteria
elastography to compare liver stiffness indices
CAP is a non-invasive additive on Fibroscan (trademark) which can quantify hepatic steatosis
the FLI is a score panel designed to screen for NAFLD
the FIB-4 is a score panel designed to screen for significant fibrosis
the NFS is a score panel designed to screen for significant fibrosis
|
この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Prevalence of NAFLD in type 1 diabetes: percentage of patients with indices of liver steatosis and/or NASH and/or fibrosis.
時間枠:one year
|
Determination of the cross-sectional prevalence of NAFLD in a cohort of type 1 diabetes patient (population size approximately 1000 subjects) according to ultrasound criteria, FLI≥60, HSI≥36, controlled attenuation parameter >215dB/m (M-probe) or ≥250 dB/m (XL probe) and MRI-PDFF >5% hepatocyte steatosis (reference method).
All measures will be performed in a combined and standardized protocol to explore their diagnostic accuracy (see outcome 4).
|
one year
|
Incidence of NAFLD in type 1 diabetes.
時間枠:five years
|
Incidence of NAFLD in type 1 diabetes determined by new cases of NAFLD according to ultrasound criteria, FLI≥60, HSI≥36, controlled attenuation parameter >215dB/m (M-probe) or ≥250 dB/m (XL probe) or MRI-PDFF >5% hepatocyte fat infiltration (reference method)
|
five years
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correlation of NAFLD with microvascular and macrovascular complications in type 1 diabetes mellitus: odds ratio to have prevalent complications in NAFLD and diabetes compared to diabetes without NAFLD
時間枠:one year
|
The correlation between indices of microvascular (neuropathy assessed by microfilament test, nephropathy assessed by microalbuminuria rate and retinopathy assessed by fundoscopic criteria) or macrovascular (non-fatal ischemic coronary disease, non-fatal cerebrovascular disease, non-fatal peripheral artery disease, or mortality due to cardiovascular disease) complications will be compared between groups with and without NAFLD as determined by the abovementioned screening tools.
|
one year
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Association of NAFLD with microvascular and macrovascular complications in type 1 diabetes mellitus: odds ratio to develop in NAFLD and diabetes compared to diabetes without NAFLD in subjects with no prior complications
時間枠:five years
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The association between indices of microvascular (neuropathy assessed by microfilament test, nephropathy assessed by microalbuminuria rate and retinopathy assessed by fundoscopic criteria) or macrovascular (non-fatal ischemic coronary disease, non-fatal cerebrovascular disease, non-fatal peripheral artery disease or mortality due to cardiovascular disease) complications will be assessed between groups with and without NAFLD, but all without prior micro- or macrovascular disease as determined by the abovementioned screening tools.
|
five years
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Diagnostic accuracy of non-invasive tools for NAFLD in type 1 diabetes: comparison of AUROC and diagnostic accuracy
時間枠:five years
|
The investigators will compare the abovementioned non-invasive tools to diagnose and grade liver steatosis and fibrosis with the predefined gold standard (MRI-PDFF for steatosis and magnetic resonance elastography for fibrosis).
Correlations and agreement statistics will be performed for each index.
Using regression analysis, a new specific algorithm will be developed based on cohort-specific cutoffs.
Using longitudinal data, a prediction score will be determined to predict NAFLD occurrence or NAFLD progression.
|
five years
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Natural history of NAFLD in type 1 diabetes
時間枠:five years
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Timewise description of the progression of quantitative indices of liver steatosis and fibrosis on the abovementioned tools (ultrasound, score systems, elastography) to assess the natural evolution of NAFLD.
Every year this assay will be performed.
MRI-PDFF will be performed in 5 years as a reference method to mark the five-year follow-up window
|
five years
|
協力者と研究者
捜査官
- 主任研究者:Christophe De Block, M.D., PhD、Universiteit Antwerpen
- 主任研究者:Sven Francque, M.D., PhD、Universiteit Antwerpen
出版物と役立つリンク
一般刊行物
- European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016 Jun;64(6):1388-402. doi: 10.1016/j.jhep.2015.11.004. Epub 2016 Apr 7. No abstract available.
- de Vries M, Westerink J, Kaasjager KHAH, de Valk HW. Prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) in Patients With Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab. 2020 Dec 1;105(12):3842-53. doi: 10.1210/clinem/dgaa575.
- Tana C, Ballestri S, Ricci F, Di Vincenzo A, Ticinesi A, Gallina S, Giamberardino MA, Cipollone F, Sutton R, Vettor R, Fedorowski A, Meschi T. Cardiovascular Risk in Non-Alcoholic Fatty Liver Disease: Mechanisms and Therapeutic Implications. Int J Environ Res Public Health. 2019 Aug 26;16(17):3104. doi: 10.3390/ijerph16173104.
- Ismaiel A, Dumitrascu DL. Cardiovascular Risk in Fatty Liver Disease: The Liver-Heart Axis-Literature Review. Front Med (Lausanne). 2019 Sep 13;6:202. doi: 10.3389/fmed.2019.00202. eCollection 2019.
- De Block CEM, Shivalkar B, Goovaerts W, Brits T, Carpentier K, Verrijken A, Van Hoof V, Parizel PM, Vrints C, Van Gaal LF. Coronary artery calcifications and diastolic dysfunction versus visceral fat area in type 1 diabetes: VISCERA study. J Diabetes Complications. 2018 Mar;32(3):271-278. doi: 10.1016/j.jdiacomp.2017.11.008. Epub 2017 Nov 28.
- Hampson SJ. Nursing interventions for the first three postpartum months. J Obstet Gynecol Neonatal Nurs. 1989 Mar-Apr;18(2):116-22. doi: 10.1111/j.1552-6909.1989.tb00474.x.
研究記録日
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研究開始 (実際)
一次修了 (予想される)
研究の完了 (予想される)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
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投稿された最後の更新 (実際)
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最終確認日
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本研究に関する用語
その他の研究ID番号
- 18/32/361
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ultrasoundの臨床試験
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Academisch Medisch Centrum - Universiteit van Amsterdam...完了
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Piazza della Vittoria 14 Studio Medico - Ginecologia...募集
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Helse Nord-Trøndelag HFNorwegian University of Science and Technology; St. Olavs Hospital完了
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Innovative Medical完了
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Riverside University Health System Medical Centerわからない