28. Nonalcoholic fatty liver disease in asymptomatic T2DM patients – prevalence, risk factors and role of fibroscan

Abstract

Background and Aims: Nonalcoholic fatty liver disease (NAFLD) is now the leading cause of cirrhosis in countries where diabetes is pandemic. Most of the patients already have complications of cirrhosis at presentation. So we have conducted a prospective study to assess the prevalence, risk factors and role of non invasive assessment of liver fibrosis (Fibroscan) in asymptomatic T2DM patients for diagnosis NAFLD spectrum. Methods: 180 patients with T2DM were enrolled in study conducted at department of gastroenterology, SN medical college, Jodhpur, from Nov 2017 to Feb 2018 in conjunction with department of medicine (diabetes clinic). 11 patients (5 female, 6 male) were excluded due to other etiology for liver disease. Remaining all patients underwent detailed history, clinical, biochemical workup (including thyroid profile, fasting lipid profile and HbA1c) and ultrasound abdomen, while Fibroscan was performed in 155 patients. Results: Mean age of study cohort (n = 169) was 54.18 ± 10.76 with M:F ratio 0.97:1. Forty two percent of all patients were already taking antihypertensives and 15 patients were having diagnosed/newly detected primary hypothyroidism. Fatty liver on ultrasound was found in 35.5% (grade 1–3) while abnormal fibroscan value (>6 kPa) was found in 46.6% (range 6.7–19.6 kPa). The presence or severity of NAFLD or fibrosis had shown no relation with HbA1c, BMI, duration and family history of diabetes mellitus. Alteration in liver biochemistry (ALT/AST), were seen in patients with abnormal fibroscan values (>9 kPa). All Patients with metabolic syndrome (n = 58), had fibroscan values related to fibrosis score 2/3 and one had F4. Conclusions: NAFLD spectrum is quite prevalent in our study group without any obvious ALT/AST changes and antecedent signs/symptoms. A predisposition for NAFL/NASH is seen in patients with characteristic metabolic syndrome features. Fibroscan is better noninvasive modality in detection and grading of severity of NAFLD. The authors have none to declare.