Non-Alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes: Evaluation of Hepatic Fibrosis and Steatosis Using Fibroscan.

Tran Thi Khanh Tuong,Pham Quang Thien Phu,Dang Khoa Tran,Tong Nguyen Diem Hong,Thien Chu Dinh,Dinh Toi Chu

doi:10.3390/diagnostics10030159

Tran Thi Khanh Tuong, Pham Quang Thien Phu + Show 4 more

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https://doi.org/10.3390/diagnostics10030159

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Journal: Diagnostics	Publication Date: Mar 14, 2020
Citations: 31	License type: CC BY 4.0

Affiliation: Pham Ngoc Thach University of Medicine

Abstract

Patients with type 2 diabetes mellitus (T2DM) are at increased risk of non-alcoholic fatty liver disease (NAFLD) and might eventually progress to advanced fibrosis, cirrhosis and hepatocellular carcinoma (HCC). Recommendations on whether to screen for NAFLD in diabetic patients remains conflicted between major guidelines. Transient elastography using FibroScan with CAP (controlled attenuation parameter) can assess both liver steatosis and fibrosis simultaneously. This paper took a new look at the prevalence of NAFLD and the severity of fibrosis among T2DM patients in Vietnam. The study was conducted using a cross-sectional design in T2DM adults who attended Dai Phuoc Ho Chi Minh Polyclinic and Polyclinic of Pham Ngoc Thach University of Medicine. Liver steatosis and fibrosis was assessed by FibroScan. NAFLD was diagnosed if CAP > 233 dB/m (steatosis > 5%). Data were analyzed using STATA 12 software program. We found that a total of 307 type 2 diabetic patients qualified for the study’s criteria. The prevalence of NAFLD in T2DM patients based on FibroScan was 73.3%. Rates of mild, moderate and severe steatosis were 20.5%, 21.8% and 30.9%, respectively. The prevalence of significant fibrosis (≥ F2), advanced fibrosis (≥ F3) and cirrhosis (F4) was 13.0%, 5.9% and 3.6%, respectively. On multivariate analysis, aspartate aminotransferase (AST) (OR: 1.067; 95% CI: 1.017–1.119; p = 0.008) and platelet levels (OR: 0.985; 95% CI: 0.972–0.999; p = 0.034) were independent of risk factors of advanced fibrosis. Thus, our study supports screening for NAFLD and for evaluating the severity of liver fibrosis in T2DM patients.

Highlights

Estimated incidences of non-alcoholic fatty liver disease (NAFLD) worldwide have increased twice in the last two decades, while the incidences of other chronic liver diseases (CLD) have remained unchanged or are on downward trends [1]
There was no statistical difference in the prevalence of central obesity between men and women, which consisted of 63.5% for both sexes
In our study of 307 type 2 diabetes mellitus (T2DM) patients who underwent transient elastography (TE), we found a high prevalence of NAFLD

Summary

Introduction

Estimated incidences of non-alcoholic fatty liver disease (NAFLD) worldwide have increased twice in the last two decades, while the incidences of other chronic liver diseases (CLD) have remained unchanged or are on downward trends [1]. NAFLD has been reported as a burden condition only in the United States (US) or Western countries. 30%, whereas in Asia the prevalence is around 25%, like many Western countries [3]. Almost all NAFLD patients have simple steatosis only, 10%–20% of patients represent the active form: non-alcoholic steatohepatits (NASH) [1]. NAFLD patients are at 64 times higher risk of cardiovascular disease (CVD) including coronary artery disease and stroke than patients without NAFLD [4]. Mortality in NAFLD patients is mostly due to CVD events, markedly exceeding the common population [5]

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