Abstract
CONTEXT: Regardless 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. OBJECTIVE: To determine the frequency of screening for MASLD in young adults with T2D attending outpatient clinics. METHODS: A 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. RESULTS: Of 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. CONCLUSION: Screening 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.