2224-P: Optimal Age to Initiate Liver Fibrosis Screening in MASLD and Type 2 Diabetes

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Introduction and Objective: MASLD affects 70% of people with type 2 diabetes mellitus (T2DM). Although some guidelines recommend screening for significant fibrosis (≥F2) after age 50, the optimal start age remains uncertain. We aimed to identify the optimal age to detect significant fibrosis in MASLD, stratified by T2DM status. Methods: Retrospective cohort study of adults with MASLD who fulfilled the 2023 SLD criteria from 17 countries in the Americas, Europe, and Asia (2014-2025). Sociodemographic and clinical data, vibration-controlled transient elastography (VCTE), and liver biopsy (when available) were recorded. Patients with other causes of liver disease were excluded. The primary outcomes were the prevalence of significant fibrosis stratified by T2DM status and PNPLA3 genotype. A binary logistic regression adjusted by age, sex, body mass index (BMI), type 2 diabetes, hypertension, and dyslipidemia was performed. Results: We included 8,867 adults (mean age 53.5±13.1 years, and 48.8% women). T2DM was present in 37.3%, and the mean BMI was 30.6±6.6 kg/m². A total of 35.9% participants had significant fibrosis. Age-stratified analyses showed a consistently higher prevalence of significant fibrosis among individuals with T2DM. In the youngest stratum (20-30 years), significant fibrosis was present in 37.2% with T2DM versus 22.6% without T2DM (p=0.007). This difference widened among intermediate- and older-age strata. In the PNPLA3 genotyping subanalysis (n=1,311), T2DM was associated with a higher frequency of significant fibrosis even in the wild-type genotype (PNPLA3 C/C: 39.7% with T2DM vs 26.4% without T2DM; p=0.001). In the adjusted model, T2DM was independently associated with increased odds of significant fibrosis (OR 1.40; 95% CI 1.21-1.62; p<0.001). Conclusion: In this large multinational cohort of MASLD, significant fibrosis was common among young individuals with T2DM. Notably, this risk remained high even among those at low genetic risk (PNPLA3 C/C). Our findings support fibrosis risk assessment at the time of T2DM diagnosis, independently of age. Disclosure J. Perelli: Speaker's Bureau; Ended; Abbott Diabetes, Boehringer Ingelheim International GmbH, Novo Nordisk. F. Idalsoaga: None. M. Arrese: None. J.P. Arab: None. L.A. Díaz: None.

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