Screening for the Prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) Among Patients With Prediabetes and Type 2 Diabetes: A Comparison of Three Screening Systems

Purpose: To screen for the prevalence and severity of nonalcoholic fatty liver disease (NAFLD) and degree of liver fibrosis in patients with prediabetes and Type 2 diabetes. Additionally, we sought to compare the results obtained from different screening systems.Methods: We screened 254 patients for NAFLD using three systems: Fatty Liver Index (FLI), Fibrosis 4 (FIB‐4) Index, and NAFLD Fibrosis Score (NFS). About two‐thirds were females (63%). The mean age was 59.15 ± 10.09 years, and mean BMI was 34.14 ± 6.60 kg/m2. Among participants, 85.5% had Type 2 diabetes and 14.5% had prediabetes. Additionally, 81.1% were on metformin, and 39.6% were on insulin.Results: Probable steatosis (NAFLD) prevalence was 77.0% (FLI score) in our cohort. Moderate to advanced liver fibrosis was 12.6% (NFS score) and 20.7% (FIB‐4 score). Significant discrepancies were noted: FIB‐4 identified 21.6% of patients with moderate to severe fibrosis, which FLI did not recognize as NAFLD. FIB‐4 also identified 26 patients with moderate to severe fibrosis that NFS missed. The FIB‐4 and FLI score discrepancy was more common in females (10.2% vs. 1.7%, p = 0.046) and in patients with diabetes compared to prediabetes (21.7% vs. 4.5%, p = 0.003). The FIB‐4 and NFS score discrepancy was more common in patients with higher BMI (38.38 ± 7.78 vs. 33.59 ± 6.82, p < 0.001) and in those with prediabetes compared to diabetes (34.8% vs. 12.8%, p = 0.008).Conclusion: The study found a high prevalence (77%) of NAFLD in individuals with prediabetes and diabetes. About 20% had moderate to advanced liver fibrosis. NAFLD prevalence and severity varied significantly across three scoring systems. Key factors for refining screening strategies include patient sex, BMI, and the level of insulin resistance.