DOI QR코드

DOI QR Code

Non-alcoholic Fatty Liver Disease (NAFLD) and Significant Hepatic Fibrosis Defined by Non-invasive Assessment in Patients with Type 2 Diabetes

  • Sobhonslidsuk, Abhasnee (Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University) ;
  • Pulsombat, Akharawit (Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University) ;
  • Kaewdoung, Piyaporn (Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University) ;
  • Petraksa, Supanna (Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University)
  • Published : 2015.03.18

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD), the most common liver problem in diabetes, is a risk factor for liver cancer. Diabetes, high body mass index (BMI) and old age can all contribute to NAFLD progression. Transient elastography (TE) is used for non-invasive fibrosis assessment. Objectives: To identify the prevalence of NAFLD and significant hepatic fibrosis in diabetic patients and to assess associated factors. Materials and Methods: One hundred and forty-one diabetic and 60 normal subjects were screened. Fatty liver was diagnosed when increased hepatic echogenicity and vascular blunting were detected by ultrasonography. Liver stiffness measurement (LSM) representing hepatic fibrosis was assessed by TE. LSM ${\geq}7$ kPa was used to define significant hepatic fibrosis. Results: Four cases were excluded due to positive hepatitis B viral markers and failed TE. Diabetic patients had higher BMI, systolic blood pressure, waist circumference and fasting glucose levels than normal subjects. Fatty liver was diagnosed in 82 (60.7%) diabetic patients but in none of the normal group. BMI (OR: 1.31; 95%CI: 1.02-1.69; p=0.038) and alanine aminotransferase (ALT)(OR: 1.14; 95%CI: 1.05-1.23; p=0.002) were associated with NAFLD. Diabetic patients with NAFLD had higher LSM than those without [5.99 (2.4) vs 4.76 (2.7) kPa, p=0.005)]. Significant hepatic fibrosis was more common in diabetic patients than in normal subjects [22 (16.1%) vs 1 (1.7%), p=0.002]. Aspartate aminotransferase (AST)(OR: 1.24; 95%CI: 1.07-1.42; p=0.003) was associated with significant hepatic fibrosis. Conclusions: Sixty and sixteen percent of diabetic patients were found to have NAFLD and significant hepatic fibrosis. High BMI and ALT levels are the predictors of NAFLD, and elevated AST level is associated with significant hepatic fibrosis.

Keywords

Diabetes;Non-alcoholic fatty liver disease (NAFLD);hepatic fibrosis;transient elastography

References

  1. Adiels M, Taskinen MR, Boren J (2008). Fatty liver, insulin resistance, and dyslipidemia. Curr Diabetes Rep, 8, 60-4. https://doi.org/10.1007/s11892-008-0011-4
  2. Alberti KGM, Zimmet P, Shaw J (2005). The metabolic syndrome: a new worldwide definition. Lancet, 366, 1059-62. https://doi.org/10.1016/S0140-6736(05)67402-8
  3. Angulo P, Hui JM, Marchesini E, et al (2007). The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology, 45, 846-54. https://doi.org/10.1002/hep.21496
  4. Bravo AA, Sheth SG, Chopra S (2001). Liver biopsy. N Engl J Med, 344, 495-500. https://doi.org/10.1056/NEJM200102153440706
  5. Casey SP, Kemp WW, Mclean CA, et al (2012). A prospective evaluation of the role of transient elastography for the detection of hepatitis fibrosis in type 2 diabetes without liver disease. Scand J Gastroenterol, 47, 836-41. https://doi.org/10.3109/00365521.2012.677955
  6. Chiou WK, Huang BY, Chou WY, et al (2011). Incidences of cancers in diabetic and non-diabetic hospitalized adult patients in Taiwan. Asian Pac J Cancer Prev, 12, 1577-81.
  7. Cusi K (2009). Nonalcoholic fatty liver disease in type 2 diabetes mellitus. Curr Opin Endocrinol Diabetes Obes, 16, 141-9. https://doi.org/10.1097/MED.0b013e3283293015
  8. Fujino Y (2007). Anthropometry, development history and mortality in the Japan collaborative cohort study for evaluation of cancer (JACC). Asian Pac J Cancer Prev, 8, 105-12.
  9. Gao J, Xie L, Yang WS, et al (2012). Risk factors of hepatocellular carcinoma--current status and perspectives. Asian Pac J Cancer Prev, 13, 743-52. https://doi.org/10.7314/APJCP.2012.13.3.743
  10. Hamer OW, Aguirre DA, Casola G, et al (2006). Fatty liver: Imaging patterns and pitfalls. Radiographics, 26, 1637-53. https://doi.org/10.1148/rg.266065004
  11. Harris MI, Flegal KM, Cowie CC, et al (1998). Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults: the Third National Health and Nutrition Examination Survey, 1988-1994. Diabetes Care, 21, 518-24. https://doi.org/10.2337/diacare.21.4.518
  12. Hernaez R, Lazo M, Bonekamp S, et al (2011). Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: A meta-analysis. Hepatology, 54, 1082-90.
  13. Jacqueminet S, Lebray P, Morra R, et al (2008). Screening for liver fibrosis by using a noninvasive biomarker in patients with diabetes. Clin Gastroenterol Hepatol, 6, 828-31. https://doi.org/10.1016/j.cgh.2008.03.005
  14. Jung KS, Kim SU (2012). Clinical applications of transient elastography. Clin Mol Hepatol, 18, 163-73. https://doi.org/10.3350/cmh.2012.18.2.163
  15. Leite NC, Salles GF, Araujo ALE, et al (2009). Prevalence and associated factors of non-alcoholic fatty liver disease in patients with type2 diabetes mellitus. Liver Int, 29, 113-9. https://doi.org/10.1111/j.1478-3231.2008.01718.x
  16. Poortahmasebi V, Alavian SM, Keyvani H, et al (2014). Hepatic steatosis: prevalence and host/viral risk factors in Iranian patients with chronic hepatitis B infection. Asian Pac J Cancer Prev, 15, 3879-84. https://doi.org/10.7314/APJCP.2014.15.9.3879
  17. Schwenzer NF, Springer F, Schraml C, et al (2009). Noninvasive assessment and quantification of liver steatosis by ultrasound, computed tomography and magnetic resonance. J Hepatol, 51, 433-55. https://doi.org/10.1016/j.jhep.2009.05.023
  18. Somboon K, Siramolpiwat S, Vilaichone RK (2014). Epidemiology and survival of hepatocellular carcinoma in the central region of Thailand. Asian Pac J Cancer Prev, 15, 3567-70. https://doi.org/10.7314/APJCP.2014.15.8.3567
  19. Teli MR, James OF, Burt AD, et al (1995). The natural history of nonalcoholic fatty liver: a follow-up study. Hepatology, 22, 1714-9. https://doi.org/10.1002/hep.1840220616
  20. Tolman KG, Foneca V, Dalpiaz A, et al (2007). Spectrum of liver disease in type 2 diabetes and management of patients with diabetes and liver disease. Diabetes Care, 30, 734-43. https://doi.org/10.2337/dc06-1539
  21. Trombetta M, Spiazzi G, Zoppini G, et al (2005). Review article: type 2 diabetes and chronic liver disease in the Verona diabetes study. Alimen Pharmacol Ther, 22, 24-7. https://doi.org/10.1111/j.1365-2036.2005.02590.x
  22. WHO (2000). World health organisation/international association for the study of obesity/international obesity taskforce. the asia-pacific perspective: redefining obesity and its treatment. http://www.idf.org.au/obesityreport.htm.
  23. Wong VWS, Vergniol J, Wong GLH, et al (2010). Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology, 51, 454-62. https://doi.org/10.1002/hep.23312
  24. Younossi ZM, Gramlich T, Matteoni CA, et al (2004). Nonalcoholic fatty liver disease in patients with type 2 diabetes. Clin Gastroenterol Hepatol, 2, 262-5. https://doi.org/10.1016/S1542-3565(04)00014-X

Cited by

  1. Reliability and applicability of two-dimensional shear-wave elastography for the evaluation of liver stiffness vol.28, pp.10, 2016, https://doi.org/10.1097/MEG.0000000000000686
  2. The Association of Gut Microbiota with Nonalcoholic Steatohepatitis in Thais vol.2018, pp.2314-6141, 2018, https://doi.org/10.1155/2018/9340316