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Screening for metabolic dysfunction-associated steatotic liver disease and advanced liver fibrosis in people with type 2 diabetes or obesity in secondary care / DAVID WILLIAMS

Swansea University Author: DAVID WILLIAMS

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DOI (Published version): 10.23889/SUThesis.72011

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognised as a complication of type 2 diabetes (T2D) and obesity, observed in around two-thirds of these patients. In people with MASLD and liver fibrosis there is major excess cardiovascular and malignancy-related mor...

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Published: Swansea 2026
Institution: Swansea University
Degree level: Doctoral
Degree name: Ph.D
Supervisor: Stephens, J. W., and Thinzar, M.
URI: https://cronfa.swan.ac.uk/Record/cronfa72011
Abstract: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognised as a complication of type 2 diabetes (T2D) and obesity, observed in around two-thirds of these patients. In people with MASLD and liver fibrosis there is major excess cardiovascular and malignancy-related morbidity and mortality. However, liver disease screening is not recommended in the United Kingdom as part of these patients’ routine care, despite growing international consensus. This is because of concerns around test accuracy, the need to re-design hepatology services, and the absence of approved pharmacological treatments. In this thesis, four studies are presented to address concerns around MASLD screening. Study 1 explores the accuracy of blood biomarkers and fibroscan for hepatic steatosis and fibrosis in a cohort of 153 patients with biopsy-confirmed MASLD. Further analysis describes the bidirectional relationship between MASLD and T2D in this cohort. Study 2 is a pilot study examining the role of additional blood tests and fibroscan to screen for MASLD in 200 people with T2D attending hospital diabetes clinics. The estimated prevalence of MASLD and advanced fibrosis were determined. The consistency between different tests was investigated, and biomarkers were correlated with cardiovascular risk. Study 3 is a pilot study examining the use of a range of screening tests for MASLD in 22 people with severe obesity undergoing bariatric surgery. The prevalence of MASLD and advanced fibrosis were determined, and test consistency was assessed. Study 4 is a questionnaire-based study to evaluate the understanding MASLD and views of screening for MASLD in 403 people with diabetes attending hospital-based diabetes clinics, and 70 clinicians practising in diabetes & endocrinology or primary care. The results from these studies support MASLD screening in the routine care of people with T2D or obesity and highlight further work and the next steps needed to support developing this process into local practice.
Keywords: metabolic dysfunction-associated steatotic liver disease, obesity, type 2 diabetes.
College: Faculty of Medicine, Health and Life Sciences
Funders: Swansea Bay University Health Board

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