Abstract
Non-alcoholic fatty liver disease (NAFLD), the most common liver problem in diabetes, is a risk factor for liver cancer. Diabetes, high body mass index (BMI) and old age can all contribute to NAFLD progression. Transient elastography (TE) is used for non-invasive fibrosis assessment. To identify the prevalence of NAFLD and significant hepatic fibrosis in diabetic patients and to assess associated factors. One hundred and forty-one diabetic and 60 normal subjects were screened. Fatty liver was diagnosed when increased hepatic echogenicity and vascular blunting were detected by ultrasonography. Liver stiffness measurement (LSM) representing hepatic fibrosis was assessed by TE. LSM ≥7 kPa was used to define significant hepatic fibrosis. Four cases were excluded due to positive hepatitis B viral markers and failed TE. Diabetic patients had higher BMI, systolic blood pressure, waist circumference and fasting glucose levels than normal subjects. Fatty liver was diagnosed in 82 (60.7%) diabetic patients but in none of the normal group. BMI (OR: 1.31; 95%CI: 1.02-1.69; p=0.038) and alanine aminotransferase (ALT)(OR: 1.14; 95%CI: 1.05-1.23; p=0.002) were associated with NAFLD. Diabetic patients with NAFLD had higher LSM than those without [5.99 (2.4) vs 4.76 (2.7) kPa, p=0.005)]. Significant hepatic fibrosis was more common in diabetic patients than in normal subjects [22 (16.1%) vs 1 (1.7%), p=0.002]. Aspartate aminotransferase (AST)(OR: 1.24; 95%CI: 1.07-1.42; p=0.003) was associated with significant hepatic fibrosis. Sixty and sixteen percent of diabetic patients were found to have NAFLD and significant hepatic fibrosis. High BMI and ALT levels are the predictors of NAFLD, and elevated AST level is associated with significant hepatic fibrosis.
Highlights
Alcohol, hepatitis B and hepatitis C viral infection are common causes of cirrhosis and hepatocellular carcinoma in Thailand and Asian countries (Gao et al, 2012; Somboon et al, 2014)
Twenty-two patients (16.1%) with diabetes had significant hepatic fibrosis, which was defined by liver stiffness measurement (LSM) ≥7.0 kPa, comparing to 1 patient (1.7%) in normal group (p=0.002)
The clinical entity of non-alcoholic fatty liver disease (NAFLD) ranges from benign simple steatosis to non-alcoholic steatohepatitis (NASH)
Summary
Hepatitis B and hepatitis C viral infection are common causes of cirrhosis and hepatocellular carcinoma in Thailand and Asian countries (Gao et al, 2012; Somboon et al, 2014). High body mass index (BMI) and type 2 diabetes mellitus are associated with an increased risk of death from cancer and ischemic heart diseases (Fujino, 2007; Chiou et al, 2011). Liver disease is the third most common cause of death in diabetic patients (Tolman et al, 2007). Non-alcoholic fatty liver disease (NAFLD), the most common liver problem in diabetes, is a risk factor for liver cancer. Objectives: To identify the prevalence of NAFLD and significant hepatic fibrosis in diabetic patients and to assess associated factors. Significant hepatic fibrosis was more common in diabetic patients than in normal subjects [22 (16.1%) vs 1 (1.7%), p=0.002]. High BMI and ALT levels are the predictors of NAFLD, and elevated AST level is associated with significant hepatic fibrosis
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