Prevalence of High-Risk Non-Alcoholic Steatohepatitis According to the Fast® Index in a Group of Diabetic Patients

Introduction and Objectives: Diabetes is a high-risk condition for the progression of metabolic fatty liver disease (MAFLD). The FAST® index combines the result of transition elastography (Fibroscan®) and AST levels and is used to predict the risk of suffering from non-alcoholic steatohepatitis (NASH) with a high risk of progression (NAS >4, F>2). This study aimed to know what proportion of diabetic patients is at risk of suffering from high-risk NASH according to the FAST® index. Materials and Methods: Observational, transversal study to estimate prevalence. Diabetic patients who agreed to perform Fibroscan® and liver biochemical profile were included, and the FAST® index was calculated (<0.35 without risk; ≤ 0.35 to <0.67 indeterminate; ≥ 0.67 high-risk NASH). Descriptive statistics were used. Results: 150 diabetic patients were included; 106 (70.7%) women; mean age 56.5±10.5 years. According to the steatosis degree by controlled attenuation parameter (CAP): S0=71(47.3%), S1=14(9.3%), S2=29(19.3%), S3=36(24%). According to the fibrosis degree (KPa): F0=82(54.7%), F1=4(2.7%), F2=8(5.3%), F3=9(6.0%), F4=47(31.3%). According to the FAST® index: without risk= 96 (64%), indeterminate= 24 (16.0%), and with high risk= 30 (20%). There was no correlation between the HbA1c levels, diabetes evolution, obesity degree or the presence of dyslipidemia. Conclusions: The NASH high-risk progression prevalence is high in diabetic patients. The factors that determine this risk in this population are still not clear, but timely detection strategies are required to efficiently identify this subgroup of patients. The FAST® index is a relatively accessible tool that, due to its non-invasive nature, could be an alternative to liver biopsy for decision-making when starting specific therapy with action at histological liver changes in NASH.