Components of Metabolic Syndrome and Type 2 Diabetes are Associated with Advanced Liver Disease

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Purpose: Components of metabolic syndrome (MS) such as obesity and type 2 diabetes (DM) are becoming increasingly prevalent in the United States. These conditions not only can cause a primary form of liver disease (non-alcoholic fatty liver disease, NAFLD), they can also enhance progression of other types of chronic liver diseases (CLD). The aim of this study was to assess the impact of a number of clinico-demographic and laboratory factors on the outcomes of patients with CLD. Methods: Patients with hepatitis B (HBV), hepatitis C (HCV), NAFLD, or other chronic liver disease (autoimmune and alcohol related liver disease, hereditary hemochromatosis etc.) were included. Clinical, demographic, laboratory and histologic data were available. Univariate and multivariate analysis with logistic regression were performed to compare diagnostic groups. Results: Five hundred ninety-four patients with CLD (193 HBV, 229 HCV, 113 NAFLD, 59 Other) were included. Demographic data for the entire cohort were as follows: 46.4% female, 51.6% Caucasian, 21% cirrhosis and age 51.4 ± 11.3. In this analysis, age was associated with cirrhosis in all diagnostic groups (HBV P= .0030, HCV P= .0043, NAFLD P= .0495, Other P= .0362). Male patients with viral hepatitis (VH: HCV and HBV) were more likely to have cirrhosis than female patients with VH (P= .0185 and .0074, respectively). In addition, HBV patients with hypertension or hyperlipidemia were more likely to be cirrhotic (P= .0370 and .0416, respectively). Patients with NAFLD and diabetes were more likely to have cirrhosis (P= .0015). Logistic regression demonstrated that elevated AST (P= .0587), ALT (P= .0390), and Total Bilirubin (P= .0280) as well as presence of DM (P= .0046) were independent predictors of cirrhosis in NAFLD. Additionally, in HBV patients, the presence of DM, hypertension or hyperlipidemia were all significant predictors of cirrhosis (P= .0491, .0081, .0141; respectively). Conclusion: Patients with CLD and DM or other components of MS are at an increased risk for cirrhosis. Optimal management of components of MS in patients with CLD may have a positive impact on the progression of liver disease.