Risk of Nonalcoholic Fatty Liver Disease (NAFLD)-Related Liver Complications in the Diabetic Population in Israel

Abstract

In the absence of early non-invasive diagnostic tools, the burden of NAFLD and its related complications in the diabetic (DM) population remains unclear. Using longitudinal data and defined criteria to identify NAFLD patients, this study evaluated the incidence of NAFLD-related liver complication in DM vs. non-DM population. The study utilized the computerized database of a nationally representative payer-provider health fund, including all members enrolled in year 2000 (index) without viral hepatitis or excess alcohol intake. NAFLD was defined as at least 2 of the following criteria: 2+ measurements of elevated liver enzymes (>2 upper normal limit), NAFLD Fibrosis score>-1.455, coded NAFLD Diagnoses, or imaging evidence using natural language processing of 1 million ultrasonography text reports. Cirrhosis, liver transplant and hepatocellular carcinoma (HCC), were detected by diagnoses, procedures, and the national cancer registry. DM was defined using a previously validated registry. Incidence density rates based on person years (PY) since index were compared between NAFLD cases vs. age and sex matched controls (2:1 ratio). The incidence was further stratified by the presence of DM. The total population included 1,083,4subjects with a mean follow-up of 15.1 years (SD=4.2).Out of these, n=61,644 were identified as NAFLD, with a mean age of 52.1 years (SD=13.6) and 23.4% with DM when they met the criteria for NAFLD. The incidence of cirrhosis, HCC and liver transplant was substantially higher in NAFLD cases as compared with matched controls with rate ratios of 5.6 (95% CI: 5.2-6.0), 1.3 (1.2-1.4) and 3.9 (2.9-5.2) respectively. After stratification by DM, rate ratios were 2.2 (95% CI: 2.0-2.3) for cirrhosis, 2.1 (1.8-2.5) for HCC and 2.5 (1.7-3.5) for liver transplant in NAFLD with DM vs. NAFLD without DM. This study shows that patients identified with NAFLD had higher rates of liver complications and these rates were increased among patients with DM. Disclosure I. Goldshtein: None. G. Fernandes: Employee; Self; Merck & Co., Inc.. Employee; Spouse/Partner; Janssen Research & Development. Stock/Shareholder; Self; Merck & Co., Inc.. Stock/Shareholder; Spouse/Partner; Janssen Research & Development. G. Chodick: None. S. Rajpathak: Employee; Self; Merck & Co., Inc. A. Karasik: Stock/Shareholder; Self; Novo Nordisk A/S. Research Support; Self; Novo Nordisk A/S. Advisory Panel; Self; Novo Nordisk A/S, AstraZeneca. Research Support; Self; AstraZeneca. Consultant; Self; Boehringer Ingelheim GmbH. Advisory Panel; Self; Merck & Co., Inc., GlucoMe.