{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:46:24Z","timestamp":1787791584038,"version":"build-2784847793"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,5,6]],"date-time":"2021-05-06T00:00:00Z","timestamp":1620259200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009032","name":"Pfizer UK","doi-asserted-by":"publisher","award":["Unrestricted Investigator led grant"],"award-info":[{"award-number":["Unrestricted Investigator led grant"]}],"id":[{"id":"10.13039\/100009032","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000589","name":"Chief Scientist Office","doi-asserted-by":"publisher","award":["CZQ\/1\/38"],"award-info":[{"award-number":["CZQ\/1\/38"]}],"id":[{"id":"10.13039\/501100000589","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["G0500877"],"award-info":[{"award-number":["G0500877"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Obesity Science &amp; Practice"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Type 2 diabetes (T2D) is associated with increased risk of progression to cirrhosis and hepatocellular carcinoma (HCC) in people with chronic liver diseases, particularly non\u2010alcoholic fatty liver disease (NAFLD). However, the absolute risk of progression is low. So, it is crucial to accurately identify patients who would benefit most from hepatology referral and intensified management. Current risk\u2010stratification tools are suboptimal and perform worse in people with diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To determine whether the addition of complementary biomarker(s) to current NAFLD risk\u2010stratification tools in people with T2D could improve the identification of people who are at increased risk of developing incident cirrhosis or HCC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The Edinburgh Type 2 diabetes Study (ET2DS) is a cohort study of men and women with T2D (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a01066, age 60\u201375 at baseline). Cases of cirrhosis and HCC were identified over 11 years of follow\u2010up. Biomarkers were measured at baseline and year 1 and association with incident disease was assessed using logistic regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of existing risk\u2010stratification scores tested, the Fibrosis\u20104 (FIB\u20104) index and the AST:platelet ratio index (APRI) performed best in this cohort. Addition of hyaluronic acid (cut\u2010point\u00a0\u2265\u00a050\u00a0\n                      <jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"graphic\/osp4484-math-0001.png\" xlink:title=\"urn:x-wiley:20552238:media:osp4484:osp4484-math-0001\"\/>\n                      \u00a0g\/L) to FIB\u20104 (cut\u2010point\u00a0\u2265\u00a01.3) maintained a false negative rate of \u226425% and reduced the number of people incorrectly identified as \u201chigh risk\u201d for incident disease by \u223c50%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The addition of hyaluronic acid to FIB\u20104 reduced the proportion of people inappropriately identified as \u201chigh risk\u201d for development of cirrhosis\/HCC in a community population of otherwise asymptomatic people with T2D. These findings require a validation in independent cohorts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/osp4.484","type":"journal-article","created":{"date-parts":[[2021,2,17]],"date-time":"2021-02-17T16:05:37Z","timestamp":1613577937000},"page":"497-508","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Addition of hyaluronic acid to the FIB\u20104 liver fibrosis score improves prediction of incident cirrhosis and hepatocellular carcinoma in type 2 diabetes: The Edinburgh Type 2 Diabetes Study"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1600-559X","authenticated-orcid":false,"given":"Sheila M.","family":"Grecian","sequence":"first","affiliation":[{"name":"Usher Institute of Population Health Sciences and Informatics University of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stela","family":"McLachlan","sequence":"additional","affiliation":[{"name":"Usher Institute of Population Health Sciences and Informatics University of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan A.","family":"Fallowfield","sequence":"additional","affiliation":[{"name":"Centre for Inflammation Research Queen's Medical Research Institute University of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Hayes","sequence":"additional","affiliation":[{"name":"Centre for Inflammation Research Queen's Medical Research Institute University of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indra Neil","family":"Guha","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne R.","family":"Morling","sequence":"additional","affiliation":[{"name":"Usher Institute of Population Health Sciences and Informatics University of Edinburgh  Edinburgh UK"},{"name":"NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham  Nottingham UK"},{"name":"Division of Epidemiology and Public Health University of Nottingham  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Glancy","sequence":"additional","affiliation":[{"name":"Department of Radiology Western General Hospital  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel M.","family":"Williamson","sequence":"additional","affiliation":[{"name":"Metabolic Unit Western General Hospital  Edinburgh UK"},{"name":"Metabolic Unit Borders General Hospital  Melrose UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca M.","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Centre for Cardiovascular Science Queen's Medical Research Institute University of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian M.","family":"Frier","sequence":"additional","affiliation":[{"name":"Centre for Cardiovascular Science Queen's Medical Research Institute University of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola N.","family":"Zammitt","sequence":"additional","affiliation":[{"name":"Royal Infirmary of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackie F.","family":"Price","sequence":"additional","affiliation":[{"name":"Usher Institute of Population Health Sciences and Informatics University of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark W. 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