Dear Editor,
We recently observed a meta-analysis conducted by Han et al. [
1] published in your esteemed journal, which we examined with considerable interest. Upon review, we have identified several issues that we believe merit further attention, as they may provide valuable insights into the Diagnostic accuracy of the Fibrosis-4 index for advanced liver fibrosis in nonalcoholic fatty liver disease (NAFLD) with type 2 diabetes mellitus (T2DM).
We would like to express our gratitude for the publication by Han et al. [
1], which significantly contributes to the field. This article predominantly investigates the importance of the fibrosis-4 (FIB-4) index as a non-invasive diagnostic tool for NAFLD in individuals with T2DM. The numerous studies on the topic identified a strong correlation between T2DM and NAFLD. A meta-analysis has demonstrated that the global prevalence of NAFLD among patients with T2DM researched 55.5% (95% CI 47.3–63.7) [
2]. Within this meta-analysis, a notable proportion exhibit advanced advanced liver fibrosis (17.0%, 95% CI 7.2–34.8). Consequently, the early detection of liver fibrosis progression in NAFLD patients with concurrent T2DM is of critical importance. This study represents the first investigation into the clinical relevance of the non-invasive diagnostic marker FIB-4, specifically examining its utility in the non-invasive diagnosis of liver fibrosis in NAFLD patients with T2DM.
However, the article has the following issues to be addressed. Firstly, the research did not distinguish between cross-sectional and cohort studies, choosing instead to include them for analysis. This methodological decision may impact the final outcomes. Secondly, an increasing number of literature suggests that FIB-4 has predictive value regarding renal function [
3]. However, in this article, it is noteworthy that a substantial proportion of the patients [
4] included in the studies exhibit renal insufficiency, potentially affect the predictive accuracy of FIB-4. Last but not least, according to the references cited in the text, three studies from the same researcher [
5-
7] may be an overlap in patient populations across these researches, and the number of patients included is large, which could further contribute to bias in the findings.
In conclusion, this article elucidates the diagnostic utility of the FIB-4 index in assessing liver fibrosis among patients with NAFLD and T2DM, thereby presenting a potential advancement in non-invasive diagnostic methods. Nevertheless, the limited specificity and sensitivity of the FIB-4 index constrain its clinical applicability. The implementation of non-invasive diagnostic markers for the screening of liver fibrosis in patients with NAFLD and T2DM represents a promising and advantageous endeavor.
ACKNOWLEDGMENTS
Tianjin Medical University Endocrine and Metabolic Disease the Youth Talent Incubator Program (2024XKNFM07).
FOOTNOTES
-
Authors’ contribution
All of the authors contributed substantially to the preparation of this paper. All authors have read and agreed to the published version of the manuscript.
-
Conflicts of Interest
The authors have no conflicts to disclose.
Abbreviations
non-alcoholic fatty liver disease
REFERENCES
- 1. Han JW, Kim HY, Yu JH, Kim MN, Chon YE, An JH, et al. Diagnostic accuracy of the Fibrosis-4 index for advanced liver fibrosis in nonalcoholic fatty liver disease with type 2 diabetes: A systematic review and meta-analysis. Clin Mol Hepatol 2024;30(Suppl):S147-S158.
- 2. Younossi ZM, Golabi P, de Avila L, Paik JM, Srishord M, Fukui N, et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and metaanalysis. J Hepatol 2019;71:793-801.
- 3. Supriyadi R, Yanto TA, Hariyanto TI, Suastika K. Utility of noninvasive liver fibrosis markers to predict the incidence of chronic kidney disease (CKD): A systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr 2023;17:102814.
- 4. Singh A, Gosai F, Siddiqui MT, Gupta M, Lopez R, Lawitz E, et al. Accuracy of noninvasive fibrosis scores to detect advanced fibrosis in patients with type-2 diabetes with biopsyproven nonalcoholic fatty liver disease. J Clin Gastroenterol 2020;54:891-897.
- 5. Bril F, Leeming DJ, Karsdal MA, Kalavalapalli S, Barb D, Lai J, et al. Use of plasma fragments of propeptides of type iii, v, and vi procollagen for the detection of liver fibrosis in type 2 diabetes. Diabetes Care 2019;42:1348-1351.
- 6. Bril F, McPhaul MJ, Caulfield MP, Clark VC, Soldevilla-Pico C, Firpi-Morell RJ, et al. Performance of plasma biomarkers and diagnostic panels for nonalcoholic steatohepatitis and advanced fibrosis in patients with type 2 diabetes. Diabetes Care 2020;43:290-297.
- 7. Bril F, Godinez Leiva E, Lomonaco R, Shrestha S, Kalavalapalli S, et al. Assessing strategies to target screening for advanced liver fibrosis among overweight and obese patients. Metab Target Organ Damage 2022;2:11.
Citations
Citations to this article as recorded by
- Age serves as the silent architect of FIB-4’s precision in unveiling advanced hepatic fibrosis in MASLD with T2DM: Correspondence to letter to the editor on “Diagnostic accuracy of the fibrosis-4 index for advanced liver fibrosis in nonalcoholic fatty liv
Ji Won Han, Dae Won Jun
Clinical and Molecular Hepatology.2025; 31(2): e152. CrossRef
