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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We thank the authors of the Letter to the Editor devised about our manuscript entitled &#8220;The presence of diabetes impacts liver fibrosis and steatosis by transient elastography in a primary care population&#8221;&#44; where we demonstrate a strong association between type 2 diabetes mellitus &#40;T2DM&#41; and increased hepatic steatosis and fibrosis on noninvasive measurement with transient elastography &#40;TE&#41;&#46; We appreciate the insightful commentary&#44; but respectfully disagree with some of their conjecture&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">First off&#44; we agree the duration of T2DM and poor glycemic control influence the progression of liver disease&#46; The primary endpoint of our study&#44; however&#44; was to evaluate whether the presence of T2DM influences steatosis and fibrosis on TE&#44; compared to those <span class="elsevierStyleItalic"><span class="elsevierStyleUnderline">without</span></span> T2DM irrespective of disease duration&#46; Data on duration of disease is not reliable and therefore not included in our results&#46; However&#44; the primary care-based population of this cohort represents the disease phenotype of the community and enhances the generalizability of our results regardless of duration of disease&#46; Secondly&#44; the profound statistically significant results we demonstrate are likely to remain significant even if duration of T2DM were accounted for&#46; We also agree that poor glycemic control likely influences liver disease progression&#46; However&#44; the studies quoted in the Letter to the Editor describe cohorts with hepatitis C virus&#44; which is a vastly different population we evaluated in this study&#46; Regardless&#44; we adjust for hemoglobin A1c&#44; a measure of glycemic control&#44; in our regression model which reduces the impact it may have on our results&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The authors in the Letter to the Editor also point out differences in the baseline demographics between the two study groups&#46; This is an inherent characteristic of observational studies that can only be avoided by randomization&#46; Additionally&#44; mentioned factors such as EZH1&#44; EZH2 and OAP&#44; are not routinely measured in the clinical scenario we are evaluating and are not relevant in this study&#46; The authors of the Letter also mention there was no explanation for our adjustment strategy&#44; however&#44; this is false&#46; I would like to refer them to the Statistical analysis section&#44; which explains the <span class="elsevierStyleItalic"><span class="elsevierStyleUnderline">stepwise</span></span> method employed for our regression analysis&#44; a commonly used technique for multivariable adjustment&#46; While we agree that longitudinal&#44; prospective trials are required in this area of study&#44; we are confident our results are hypothesis generating and reproduce similar findings demonstrated in study populations outside of the United States&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">There are no conflicts of interest or funding to report for the creation of this manuscript&#46;</p></span></span>"
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