High Prevalence of Liver Fibrosis in Mexican Patients with Type 2 Diabetes Detected by Transitory Elastography

Abstract

Introduction: The prevalence of non alcoholic fatty liver disease (NAFLD) varies between 2 and 25% in open population and between 70 and 80% among patients with risk factors. Studies in Mexican patients with type 2 diabetes have shown prevalence between 14 and 18% using hepatic ultrasound and hepatic function tests. Our aim was to identify the prevalence of NAFLD and hepatic fibrosis by transitory elastography in Mexican patients with type 2 diabetes, and to identify clinical predictors of NAFLD and hepatic fibrosis in this population. Methods: Study of ambulatory patients who attended the Diabetes Clinic in a tertiary referral center from January to December 2015. We included type 2 diabetes patients without a history of hepatic disease and a weekly alcohol intake lower than 20 g/week. Each patient had transitory elastography and antropometric parameters measurements (weight, size, BMI and waist/hip index). The percentage of fat infiltration (S) was defined as SO (200 to 22 CAP), S1 (223 to 233 CAP), S2 (234 to 290 CAP) and S3 (>290CAP). We realized descriptive statistics, the frequencies are shown as percentages. To make a comparison between groups, we used X2 test. Finally, a Spearman and Pearson coefficient was made. Results: 42 patients were included, 15 man (36%) and 27 women (64%). The mean age was 57±9.5 years. 50% (n=21) of the population had arterial hipertension, 76% (n=32) matched diagnosis criteria for metabolic syndrome and 64% (n=27) had dyslipidemia. The mean evolution time of type 2 diabetes was 10.4 ±8.2 years. 83% of the population had fatty liver disease S (CAP>200dB/m) and 26% (n=11) had hepatic fibrosis (E>6.2kPa); among them 5 patients had F1, 3 patients F2, 2 patients F3 and 1 patient F4. We found an important association between S and dyslipidemia (p < 0.005). A positive correlation between age and time of evolution was found R=0.455, p=0.002; between weight and CAP r=0.686, p < 0.001; between BMI and CAP r=0.600, p < 0.001, between BMI and kPa 0.328 p < 0.05, between waist circumference and CAP r=0.479,p=0.001; between hip circumference and kPa r=0.377 p < 0.05; between waist perimeter and CAP r=0.364, p < 0.05 and between hip circumference and kPa r=0.356, p < 0.05. Conclusion: The prevalence of NAFLD and hepatic fibrosis in Mexican patients with type 2 diabetes is very high. The antropometric parameters are usefull to predict hepatic fat infiltration and hepatic fibrosis, and they should be used to identify the risk population.