1348-P: Glycemic Control Is Associated with the Histological Severity of Nonalcoholic Fatty Liver Disease

Abstract

Background: Diabetes mellitus (DM) is a major risk for progression of nonalcoholic steatohepatitis (NASH) from nonalcoholic fatty liver (NAFL). Although DM influences on the pathophysiology of NASH, the impact of glycemic control status on the histological severity of NASH is unclear. Methods: We conducted an observational study of 331 patients (140 men and 191 women) diagnosed with nonalcoholic fatty liver disease (NAFLD) by liver biopsy. Impact of glycemic control status on histological severity of NAFLD was evaluated by comparison of the four divided groups, based on the hemoglobin A1c (HbA1c) levels: HbA1c ≤5.4%; 5.5-6.4%; 6.5-7.4%; and ≥7.5%, at the time of liver biopsy. The histological severity of NAFLD was determined by fibrosis staging; stage 0-4, and NAS score; 0-8 points. The advanced liver fibrosis and the high NAS score were defined as stage 3-4 and 5-8 points, respectively. Results: Higher HbA1c groups (5.5-6.4%; 6.5-7.4%; and ≥7.5%) were associated with advanced fibrosis compared to the lowest HbA1c group. In the multivariate analysis, the HbA1c 6.5-7.4% group was significantly associated with advanced fibrosis compared to the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index, as well as uric acid, total cholesterol, and triglyceride levels, HbA1c 5.5-6.4%, 6.5-7.4%, ≥7.5% groups were significantly associated with advanced fibrosis compared to the lowest HbA1c group. These HbA1c groups (5.5-6.4%; 6.5-7.4%; and ≥7.5%) were also associated with higher NAFLD activity scores, these associations remained significant in the multivariate analysis. Conclusions: The glycemic control status is strongly associated with the histological severity of NAFLD, even with mild deterioration in glycemic control. Therefore, adequate glycemic control in NAFLD patients might be important in improving NAFLD activity and preventing progression to NASH. Disclosure T.Miyake: None. Y.Hiasa: None. S.Furukawa: Speaker's Bureau; Kowa Company, Ltd., Ono Pharmaceutical Co., Ltd., Sanofi, Novo Nordisk, Eli Lilly Japan K.K. B.Matsuura: None. O.Yoshida: None. M.Miyazaki: None. A.Shiomi: None. S.Kanzaki: None. H.Nakaguchi: None. M.Abe: None.