{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T20:19:42Z","timestamp":1787948382076,"version":"build-2784847793"},"reference-count":26,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Exp Clin Endocrinol Diabetes"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Fibrosis-Index-4 (FIB-4) is used with a cut-off of 1.3 to exclude severe fibrosis\n                    in metabolic dysfunction-associated steatotic liver disease (MASLD). The aim of\n                    this study was to examine the potential association of FIB-4 with chronic\n                    vascular complications of type 2 diabetes mellitus (T2DM). Included were 550\n                    adults (271 men) with T2DM, mean age of 67.88\u00b111.46 years and median T2DM\n                    duration of 15 (9.75\u201322) years. FIB-4 was calculated and chronic vascular\n                    complications were recorded. Participants with FIB-4&gt;1.3 were compared with\n                    those having FIB-4\u22641.3. The former exhibited significantly more frequent\n                    peripheral neuropathy (corrected odds ratio [cOR]: 26.48, 95% confidence\n                    interval [CI]: 16.81\u201341.71, p&lt;0.001), chronic kidney disease (cOR: 33.75, 95%\n                    CI: 19.55\u201358.28, p&lt;0.001), retinopathy (cOR: 22.42, 95% CI: 14.22\u201335.34,\n                    p&lt;0.001), stroke (cOR: 2.85, 95% CI: 1.56\u20135.21, p&lt;0.001), coronary artery\n                    disease (cOR: 6.20, 95% CI: 4.25\u20139.04, p&lt;0.001) and peripheral arterial\n                    disease (cOR: 4.60, 95%-CI: 2.62\u20138.07, p&lt;0.001) than the latter. Peripheral\n                    neuropathy was staged as absent, mild and moderate-severe, based on the\n                    Neuropathy Disability-Score (NDS). FIB-4 score was associated with increased\n                    clinical severity of peripheral neuropathy (p&lt;0.001).<\/jats:p>","DOI":"10.1055\/a-2765-6480","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:14:06Z","timestamp":1765584846000},"page":"19-23","source":"Crossref","is-referenced-by-count":1,"title":["Association of fibrosis index-4 (FIB-4) with chronic vascular\n                    complications of type 2 diabetes mellitus"],"prefix":"10.1055","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7320-785X","authenticated-orcid":false,"given":"Nikolaos","family":"Papanas","sequence":"additional","affiliation":[{"name":"Diabetes Centre, Second Department of Internal\n                    Medicine, Democritus University of Thrace, University Hospital of\n                    Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evanthia","family":"Gouveri","sequence":"additional","affiliation":[{"name":"Diabetes Centre, Second Department of Internal\n                    Medicine, Democritus University of Thrace, University Hospital of\n                    Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodoros","family":"Panou","sequence":"additional","affiliation":[{"name":"Diabetes Centre, Second Department of Internal\n                    Medicine, Democritus University of Thrace, University Hospital of\n                    Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grigorios","family":"Trypsianis","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, Democritus University\n                    of Thrace, University Hospital of Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Papazoglou","sequence":"additional","affiliation":[{"name":"Diabetes Centre, Second Department of Internal\n                    Medicine, Democritus University of Thrace, University Hospital of\n                    Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1212","DOI":"10.1097\/HEP.0000000000000670","article-title":"Metabolic dysfunction-associated steatotic liver disease: Update and impact of\n                    new nomenclature on the American Association for the Study of Liver Diseases\n                    practice guidance on nonalcoholic fatty liver disease","volume":"79","author":"F Kanwal","year":"2024","journal-title":"Hepatology"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.1097\/HEP.0000000000000323","article-title":"AASLD Practice Guidance on the clinical assessment and management of\n                    nonalcoholic fatty liver disease","volume":"77","author":"M E Rinella","year":"2023","journal-title":"Hepatology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1016\/S2468-1253(22)00165-0","article-title":"The prevalence and incidence of NAFLD worldwide: A systematic review and\n                    meta-analysis","volume":"7","author":"K Riazi","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1016\/S2468-1253(24)00193-6","article-title":"Natural history and progression of metabolic dysfunction-associated steatotic\n                    liver disease","volume":"9","author":"H Hagstr\u00f6m","year":"2024","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2375","DOI":"10.1016\/j.jhep.2024.04.031","article-title":"EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic\n                    dysfunction-associated steatotic liver disease (MASLD): Executive Summary","volume":"67","author":"European Association for the Study of the Liver, European\n                            Association for the Study of Diabetes, European Association for the\n                            Study of Obesity","year":"2024","journal-title":"Diabetologia"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"155642","DOI":"10.1016\/j.metabol.2023.155642","article-title":"Nonalcoholic fatty liver disease (NAFLD) and associated mortality in individuals\n                    with type 2 diabetes, pre-diabetes, metabolically unhealthy, and metabolically\n                    healthy individuals in the United States","volume":"146","author":"P Golabi","year":"2023","journal-title":"Metabolism"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"11753","DOI":"10.1038\/s41598-021-88285-6","article-title":"High FIB4 index is an independent risk factor of diabetic kidney disease in type\n                    2 diabetes","volume":"11","author":"H Saito","year":"2021","journal-title":"Sci Rep"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"823","DOI":"10.3390\/biomedicines12040823","article-title":"Elevated FIB-4 is associated with higher rates of cardiovascular disease and\n                    extrahepatic cancer history in patients with type 2 diabetes mellitus","volume":"12","author":"D S Karagiannakis","year":"2024","journal-title":"Biomedicines"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1055\/a-1831-0991","article-title":"Correlation between skin advanced glycation end products and cardiac autonomic\n                    neuropathy among subjects with type 2 diabetes mellitus","volume":"130","author":"S Papachristou","year":"2022","journal-title":"Exp Clin Endocrinol Diabetes"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1093\/ajhp\/zxaf044","article-title":"KDIGO 2024 clinical practice guideline on evaluation and management of chronic\n                    kidney disease: A primer on what pharmacists need to know","volume":"82","author":"L Awdishu","year":"2025","journal-title":"Am J Health Syst Pharm"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"557","DOI":"10.2337\/diacare.17.6.557","article-title":"The prediction of diabetic neuropathic foot ulceration using vibration\n                    perception thresholds. A prospective study","volume":"17","author":"M J Young","year":"1994","journal-title":"Diabetes Care"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"108356","DOI":"10.1016\/j.jdiacomp.2022.108356","article-title":"Skin advanced glycation end products as a screening tool of neuropathy in type 2\n                    diabetes mellitus","volume":"36","author":"S Papachristou","year":"2022","journal-title":"J Diabetes Complications"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"S252","DOI":"10.2337\/dc25-S012","article-title":"12. Retinopathy, neuropathy, and foot care: Standards of care in\n                    diabetes-2025","volume":"48","author":"American Diabetes Association Professional Practice\n                            Committee","year":"2025","journal-title":"Diabetes Care"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1002\/bimj.200710415","article-title":"Youden Index and optimal cut-point estimated from observations affected by a\n                    lower limit of detection","volume":"50","author":"M D Ruopp","year":"2008","journal-title":"Biom J"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"101087","DOI":"10.1016\/j.aohep.2023.101087","article-title":"Type 2 diabetes complications are associated with liver fibrosis independent of\n                    hemoglobin A1c","volume":"28","author":"H D Trivedi","year":"2023","journal-title":"Ann Hepatol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1186\/s12902-024-01766-3","article-title":"Increased risk of vascular complications in patients with type 2 diabetes and\n                    fatty liver disease","volume":"24","author":"W Sun","year":"2024","journal-title":"BMC Endocr Disord"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1089\/met.2024.0022","article-title":"Noninvasive liver fibrosis indices as indicators of microvascular and\n                    macrovascular complications in type 2 diabetes","volume":"22","author":"H Erman","year":"2024","journal-title":"Metab Syndr Relat Disord"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1147458","DOI":"10.3389\/fendo.2023.1147458","article-title":"Non-alcoholic fatty liver disease and incidence of microvascular complications\n                    of diabetes in patients with type 2 diabetes: A prospective cohort study","volume":"14","author":"N Deravi","year":"2023","journal-title":"Front Endocrinol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"4241","DOI":"10.1111\/dom.15758","article-title":"Impact of non-alcoholic fatty liver disease and fibrosis on mortality and kidney\n                    outcomes in patients with type 2 diabetes and chronic kidney disease: A\n                    multi-cohort longitudinal study","volume":"26","author":"L Zhao","year":"2024","journal-title":"Diabetes Obes Metab"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1016\/j.ajg.2024.04.001","article-title":"Relationship between fibrosis-4 score and microvascular complications in\n                    patients with type 2 diabetes mellitus","volume":"25","author":"B T Erdogan","year":"2024","journal-title":"Arab J Gastroenterol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1055\/a-2280-3742","article-title":"Association between liver fibrosis score and diabetic kidney disease: A\n                    retrospective cross-sectional study of hospitalized patients","volume":"132","author":"J Zhang","year":"2024","journal-title":"Exp Clin Endocrinol Diabetes"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"107879","DOI":"10.1016\/j.jdiacomp.2021.107879","article-title":"Importance of non-invasive liver fibrosis scores for mortality and complications\n                    development in individuals with type 2 diabetes","volume":"35","author":"N C Leite","year":"2021","journal-title":"J Diabetes Complications"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"3248","DOI":"10.3390\/nu15143248","article-title":"Change in liver fibrosis associates with progress of diabetic nephropathy in\n                    patients with nonalcoholic fatty liver disease","volume":"15","author":"Y Terasaka","year":"2023","journal-title":"Nutrients"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1159\/000531574","article-title":"Hepatic fibrosis evaluated in patients with type 2 diabetes with and without\n                    chronic kidney disease","volume":"147","author":"T Adrian","year":"2023","journal-title":"Nephron"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"24372","DOI":"10.1038\/s41598-021-03870-z","article-title":"Liver fibrosis indices are related to diabetic peripheral neuropathy in\n                    individuals with type 2 diabetes","volume":"11","author":"K Kim","year":"2021","journal-title":"Sci Rep"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2019","DOI":"10.1111\/jdi.13562","article-title":"Liver fibrosis is independently associated with diabetic peripheral neuropathy\n                    in type 2 diabetes mellitus","volume":"12","author":"J Huang","year":"2021","journal-title":"J Diabetes Investig"}],"container-title":["Experimental and Clinical Endocrinology &amp; Diabetes"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2765-6480.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T23:53:20Z","timestamp":1770854000000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2765-6480"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,12]]},"references-count":26,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2026,2,11]]},"published-print":{"date-parts":[[2026,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2765-6480","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0947-7349","1439-3646"],"issn-type":[{"value":"0947-7349","type":"print"},{"value":"1439-3646","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12,12]]},"published":{"date-parts":[[2025,12,12]]}}}