PREVALENCE OF NAFLD AND IT’S ASSOCIATION WITH INSULIN RESISTANCE IN PATIENTS WITH DIABETES

Abstract

Objectives: Non Alcoholic Fatty Liver Disease (NAFLD) is characterized by fatty infiltration of the liver, mostly in the form of triglycerides (TG), which exceeds 5% of the liver weight.NAFLD is strongly associated with Insulin Resistance(IR).Patients with NAFLD also having type 2 diabetes carry added risk of progressive forms of the disease particularly cirrhosis. They also have poor glycemic control owing to IR. So it is logical to identifying the patients with diabetes having NAFLD could estimates the future risk and help in prevention of chronic liver disease and delaying the progression to NASH and cirrhosis and various complications of Diabetes.
 Methods: This was a cross sectional observational study conducted in department of medicine, N.S.C.B., MCH, Jabalpur in which 100 cases of diabetes were taken who satisfied inclusion and exclusion criteria. Abdominal USG was used for evidence of fatty liver and it’s grading and fasting serum levels of insulin (FIL) and fasting blood sugar(FBS) were used to calculate HOMA IR value to find presence of IR.
 Results: Our study showed prevalence of NAFLD was 56%(n-56),Among these,in 58.92%(n-33) cases NAFLD is associated with IR(chi square value-4.1,p value-0.041).Prevalence of NAFLD was slightly more in females-56.6%(n-30) as compare to males-55.32%(n-26).Strong association of NAFLD with IR is found among females as compare to males (p-0.022 and p-0.79 respectively). Waist circumference, Mean BMI, FBS, Triglycerides, FIL and HOMA IR levels in cases with NAFLD (95.11±12.46, 24.83±2.42, 176.13±66.79, 180.07±51.35, 13.59±15.42, 5.33±5.21)were higher as compare to non NAFLD (85.84±9.86, 22.41±2.16, , 134.8±34.41,139.09±39.27, 6.79±4.49, 2.37±1.94)respectively. The mean AST and ALT levels were higher in NAFLD group than Non NAFLD group (t= 2.23,2.19) respectively with p value <0.05.Prevalence of NAFLD was 88.23%(n-15)in obese population.
 Conclusion: Given the high prevalence of NAFLD in patients with diabetes, the possibility of NAFLD should be suspected in all of them. These patients with NAFLD have high propensity of IR than Non NAFLD patients, so are at higher risk of developing complications of diabetes, NASH and cirrhosis. Also obese diabetic patients have higher incidence of NAFLD and IR as compared to non-obese patients. It seems reasonable to expect that early diagnosis of NAFLD and early intervention with strict glycemic control and weight loss would prevent complications.