الفهرس 
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Abstract
Non-alcoholic fatty liver disease is a range of liver disorders that includes hepatic steatosis, steatohepatitis, and hepatic fibrosis. This may further progress to cirrhosis and hepatocellular carcinoma. In the present cross sectional study we aimed to assess NAFLD among diabetic, pre-diabetic and controls participants using non-invasive methods among patients admitted or attended to the outpatient’s clinic of the Internal Medicine Department, Assiut University Hospital during the period from the 1st of January 2021 up to the end of December 2021.
This study included 150 participants who were divided into three groups:
group 1: Diabetic group (n=50).
group 2: Pre-diabetic group (n=50).
group 3: Control group (n=50).
Eligible participants were subjected to the following preliminary evaluation:
1. Full history taking: including name, age, sex, address, disease duration for diabetic patients.
2. Anthropometric measures: including height (cm), weight (kg), body mass index (kg/m²)
3. Systemic examination: including cardiac, chest and abdominal examination.
4. Laboratory tests: including CBC, FBG, HbA1C, liver and kidney function tests, lipid profile, and hepatitis marker.
5. Radiological:\Fibroscan
In the current study we were trying to validate the role of non-invasive methods that have been used to predict the presence and risk stratification of liver fibrosis and steatosis among the studied subjects. These methods include non-invasive fibrosis markers using serological tests as (FIB-4, and NFS) and steatosis markers using serological tests as (HSI, and FLI), and we used radiological tests as (steatosis read cap and fibrosis reading) as a gold stander.
Main finding of the current study:
Diabetic patients have significantly older age, higher BMI, and waist circumference.
For coagulation profile; diabetic patients have significantly reduced PT &INR, and lower PC compared to the other two groups.While the pre-diabetic patients have significantly prolonged PT and lower PC compared to the control group.
For liver function tests; diabetic patients have significantly lower TP, and albumin level compared to the other studied groups, and higher GGT compared to the control group.In addition pre-diabetic patients have significantly lower TP and higher GGTcompared to the control group.
For kidney function tests; diabetic patients and pre-diabetic group have significantly higher serum urea level compared to the control group, while diabetic patients have significantly higher serum createnine level compared to the other two groups.
For lipid profile; diabetic patients have significantly higher cholesterol, triglycerides, low HDL and increased levels of LDL compared to the other two groups. Also pre-diabetic have significantly higher triglycerides level compared to control group.
Among diabetic patients; significant positive correlation was observed between hepatic Fibrosis reading and diabetic disease duration, no significant correlation was observed between hepatic Fibrosis and steatosis and HBA1c level. In addition the degree of hepatic Fibrosis and steatosis were comparable between the three different drugs used by diabetic patients.
Using FIB-4 at a cutoff value of 1.45, and NFS at a cutoff value of 0.67 were good predictors for detection of liver fibrosis. However FIB-4 was more sensitive for detection of liver fibrosis even in pre-diabetic individuals
Using HSI at a cutoff value of 36, and FLI at a cutoff value of 30 were good predictors for detection of liver steatosis.
Finally we could be concluded that the proposed composite score had a reliable and acceptable diagnostic accuracy in identifying patients at risk of having severe fibrosis and/or steatosis using readily available laboratory and clinical data.