Screening for non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus using transient elastography.

Abstract

The recommendation in regard to screening for non-alcoholic fatty liver disease (NAFLD) among type 2 diabetes mellitus (T2DM) patients differs in major guidelines. The aim of this paper was to study the prevalence of NALFD and advanced fibrosis among T2DM patients. This is a cross-sectional study of consecutive adult T2DM patients attending the Diabetes Clinic of a university hospital. Significant hepatic steatosis and advanced fibrosis was diagnosed based on transient elastography if the controlled attenuation parameter was ≥263dB/m, and the liver stiffness measurement was ≥9.6kPa using the M probe or ≥9.3kPa using the XL probe, respectively. Patients with liver stiffness measurement ≥8kPa were referred to the Gastroenterology and Hepatology Clinic for further assessment, including liver biopsy. The data of 557 patients were analyzed (mean age 61.4±10.8years, male 40.6%). The prevalence of NAFLD and advanced fibrosis based on transient elastography was 72.4% and 21.0%, respectively. On multivariate analysis, independent factors associated with NAFLD were central obesity (OR 4.856, 95% confidence interval [CI] 2.749-8.577, P=0.006), serum triglyceride (OR 1.585, 95% CI 1.056-2.381, P=0.026), and alanine aminotransferase levels (OR 1.047, 95% CI 1.025-1.070, P<0.001) while advanced fibrosis was associated with serum high-density lipoprotein cholesterol (OR 0.355, 95% CI 0.126-0.997, P=0.049), alanine aminotransferase (OR 1.023, 95% CI 1.009-1.037, P=0.001), γ-glutamyltransferase (OR 1.005, 95% CI 1.001-1.008, P=0.017), and platelet levels (OR 0.995, 95% CI 0.992-0.999, P=0.010). Seventy-one patients underwent liver biopsy. The majority had non-alcoholic steatohepatitis (83.1%) and ≥F1 fibrosis (87.3%) while advanced fibrosis was seen in 36.6%. The prevalence of NAFLD and advanced fibrosis based on transient elastography is high among T2DM patients.