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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
first_indexed 2026-06-04T10:49:09Z
last_indexed 2026-06-05T10:54:46Z
id cronfa72011
recordtype RisThesis
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spelling 2026-06-04T11:53:21.3165337 v2 72011 2026-06-04 Screening for metabolic dysfunction-associated steatotic liver disease and advanced liver fibrosis in people with type 2 diabetes or obesity in secondary care 4471cebf3d9f06d7be297c95c4eef73a DAVID WILLIAMS DAVID WILLIAMS true false 2026-06-04 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. E-Thesis Swansea metabolic dysfunction-associated steatotic liver disease, obesity, type 2 diabetes. 27 5 2026 2026-05-27 10.23889/SUThesis.72011 COLLEGE NANME COLLEGE CODE Swansea University Stephens, J. W., and Thinzar, M. Doctoral Ph.D Swansea Bay University Health Board Swansea Bay University Health Board 2026-06-04T11:53:21.3165337 2026-06-04T11:37:35.6739963 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Biomedical Science DAVID WILLIAMS 1 72011__36860__ff509128c56345c590af92a108b2146b.pdf 2026_Williams_D.final.72011.pdf 2026-06-04T11:48:16.2517225 Output 10054150 application/pdf E-Thesis – open access true Copyright: the author, David Michael Williams, 2026. true eng
title Screening for metabolic dysfunction-associated steatotic liver disease and advanced liver fibrosis in people with type 2 diabetes or obesity in secondary care
spellingShingle 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
title_short Screening for metabolic dysfunction-associated steatotic liver disease and advanced liver fibrosis in people with type 2 diabetes or obesity in secondary care
title_full Screening for metabolic dysfunction-associated steatotic liver disease and advanced liver fibrosis in people with type 2 diabetes or obesity in secondary care
title_fullStr Screening for metabolic dysfunction-associated steatotic liver disease and advanced liver fibrosis in people with type 2 diabetes or obesity in secondary care
title_full_unstemmed Screening for metabolic dysfunction-associated steatotic liver disease and advanced liver fibrosis in people with type 2 diabetes or obesity in secondary care
title_sort Screening for metabolic dysfunction-associated steatotic liver disease and advanced liver fibrosis in people with type 2 diabetes or obesity in secondary care
author_id_str_mv 4471cebf3d9f06d7be297c95c4eef73a
author_id_fullname_str_mv 4471cebf3d9f06d7be297c95c4eef73a_***_DAVID WILLIAMS
author DAVID WILLIAMS
author2 DAVID WILLIAMS
format E-Thesis
publishDate 2026
institution Swansea University
doi_str_mv 10.23889/SUThesis.72011
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Biomedical Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Biomedical Science
document_store_str 1
active_str 0
description 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.
published_date 2026-05-27T06:39:49Z
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score 11.108426

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