{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T22:10:24Z","timestamp":1790719824585,"version":"4.1.0"},"reference-count":46,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T00:00:00Z","timestamp":1632355200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Obesity"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study assessed the impact of diabetes mellitus (DM) on nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) with advanced fibrosis prevalence in adults with overweight or obesity in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants (National Health and Nutrition Examination Survey [NHANES] 2015\u20102016 database) included 834 middle\u2010aged patients with DM (21.7%) and 3,007 without DM (78.3%). NAFLD was defined by Fatty Liver Index (FLI) \u2265 60 or United States FLI (USFLI) \u2265 30. Moderate\u2010to\u2010high and high risk of advanced fibrosis was defined by fibrosis\u20104 index (FIB\u20104) \u2265 1.67 and \u2265 2.67, respectively, and NAFLD fibrosis scores &gt; 0.676 also indicated a high risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      NAFLD prevalence increased with BMI. Steatosis was higher in individuals with overweight with DM versus without DM (USFLI \u2265 30: 48.3% vs. 17.4%;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.01) and in individuals with obesity with DM versus without DM (USFLI \u2265 30: 79.9% vs. 57.6%;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.01). DM significantly increased the proportion of individuals at moderate\u2010to\u2010high risk of fibrosis (FIB\u20104 \u2265 1.67: 31.8% vs. 20.1%;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). In the high risk of advanced fibrosis group (FIB\u20104 \u2265 2.67), the risk almost doubled (3.8% vs. 7.1%). Among individuals with obesity, DM increased the proportion of adults with moderate and high risk of fibrosis by 1.8\u2010 and 2.5\u2010fold, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.01 and\n                      <jats:italic>p =<\/jats:italic>\n                      0.39, respectively, vs. without DM).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this US cohort, DM modestly impacted steatosis, which was primarily obesity\u2010driven. DM added a significant risk of fibrosis to individuals with overweight or obesity, suggesting that screening is imperative in adults with DM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/oby.23263","type":"journal-article","created":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T07:59:35Z","timestamp":1632383975000},"page":"1950-1960","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":139,"title":["Type 2 diabetes mellitus increases the risk of hepatic fibrosis in individuals with obesity and nonalcoholic fatty liver disease"],"prefix":"10.1002","volume":"29","author":[{"given":"Diana","family":"Barb","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism University of Florida Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico M.","family":"Repetto","sequence":"additional","affiliation":[{"name":"Global Medicines Development AstraZeneca plc Gaithersburg Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Stokes","sequence":"additional","affiliation":[{"name":"Real\u2010World Evidence Evidera, Waltham Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudha S.","family":"Shankar","sequence":"additional","affiliation":[{"name":"Early Clinical Development AstraZeneca plc Gaithersburg Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8629-418X","authenticated-orcid":false,"given":"Kenneth","family":"Cusi","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism University of Florida Gainesville Florida USA"},{"name":"Division of Endocrinology, Diabetes and Metabolism Malcom Randall Veterans Affairs Medical Center Gainesville Florida 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