Prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) in Obese Type Two Diabetes Patients in an Endocrine Clinic

Abstract

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver diseases that is expected to become the main cause for liver transplantation by 2030.1 Its prevalence is increasing globally and regionally, and it is set to become the leading cause of chronic liver disease in many parts of the world. However, the epidemiology and demographic characteristics of NAFLD vary worldwide.2About 20% to 30% of the patients progress to develop nonalcoholic steatohepatitis (NASH), a subtype of NAFLD, with features of hepatocyte injury such as hepatocyte ballooning. NASH can develop to fibrosis, cirrhosis, and even hepatocellular carcinoma.3 NAFLD is correlated with obesity and insulin resistance in most cases in the Western world.2In Kuwait, obesity prevalence is estimated to be 39% for adult males and 52% for adult females.4 There is no pharmacotherapy approved for NAFLD treatment, and the main treatment is lifestyle modifications focusing on body fat loss.5 Methods: In 18 months duration, a total number of 306 patients who attended an endocrine clinic in Kuwait for general health checkups with an average BMI of 33.6 (Kg/m2) were requested to do an abdominal ultrasound for fatty liver screening. And out of 306 patients, 218 patients (71% of the patients) were diagnosed with NAFLD, the rest 29% of the patients either didn’t come back for a follow up or were not diagnosed with NAFLD. Results: 218 patients have NAFLD, 153 of them are females and 65 are males with an average age and weight of 56.4 years and 87.9kg respectively. 78% of the patients were diabetic with an average HbA1c of 7.6%. The abdominal ultrasound showed the following result:83 patients had NAFLD grade 184 patients had NAFLD grade 2 21 patients had NAFLD grade 3While 30 patients had no grading, the results showed that they have a fatty liver with no grades mentioned. Also, reports showed that 27 patients had liver cirrhosis.The 218 patients were requested to do blood test and average results of the following parameter were as shown at baseline:Ferritin 98.3 ng/mLHemoglobin 13.5 g/dLPlatelets 274.5 x1000/cmmAST 23.8 U/LALT 27.9 U/LDirect Bilirubin 3.5 umol/LTotal Bilirubin 8.9 umol/LThe average calculated NAFLD, BARD and Fib-4 scores were -1.1, 3 and 1.1 respectively. All patients were unaware of NAFLD. Conclusion: 78% of the study population had NAFLD and were unaware of that. More researches on NAFLD awareness and occurrence in the region are required.