The Saudi Journal of Medical Insights

Background: Nonalcoholic fatty liver disease (NAFLD) is increasingly recognized in type 1 diabetes mellitus (T1DM),
challenging the traditional view of T1DM as pure insulin deficiency.
Objective: To synthesize evidence on NAFLD prevalence, risk factors, diagnostic approaches, and clinical implications in
T1DM.
Methods: Systematic review of PubMed, Embase, Scopus, and Cochrane Library (2021–2026). Included studies enrolling
T1DM patients with NAFLD assessed by transient elastography, MRI, ultrasound, or non-invasive scores. Ten studies
(1,765 participants) met criteria; quality assessed via JBI checklist.
Results: NAFLD prevalence in adults with T1DM ranged 11.6–43% (largest cohort: 28.5%); fibrosis prevalence 0%
(pediatric) to 11% (adults). Central obesity was the strongest risk factor (OR 3.1–4.13), followed by higher BMI, insulin
resistance markers (eGDR, VAI, TG/HDL-C), poor glycemic control, and longer diabetes duration. Notably, 59–72% of
patients with NAFLD/fibrosis had normal ALT, making liver enzymes inadequate for screening. Non-invasive tests (FIB
4, CAP) showed utility for risk stratification. Intensive lifestyle intervention improved NAFLD markers and reduced insulin
requirements in obese T1DM patients.
Conclusion: NAFLD affects ~20–30% of adults with T1DM, with a significant subset having advanced fibrosis. Routine
screening is warranted in at-risk individuals—particularly those with obesity, central adiposity, insulin resistance, or poor
glycemic control—regardless of normal ALT. Future research should explore NAFLD natural history, pharmacotherapy,
and establish evidence-based screening guidelines.