Nonalcoholic Fatty Liver Disease In Type 2 Diabetes Mellitus Patients Research Articles

Triglyceride to high-density lipoprotein cholesterol ratio as a marker of non-alcoholic fatty liver disease in type 2 diabetes

Type 2 diabetes mellitus (T2DM) and non-alcoholic liver disease (NAFLD) shared a common feature, insulin resistance (IR), which is marked by a change in the lipoprotein fraction, namely increased triglycerides (TG) and decreased high-density lipoprotein cholesterol (HDL-C) levels. Blood lipids are routinely examined in T2DM patients; thus, our study aimed to investigate the performance of TG/HDL-C ratio values to identify hepatic steatosis, the earliest manifestation of nonalcoholic fatty liver disease (NAFLD), in T2DM patients. One hundred adult T2DM patients over 30 years old were recruited from the diabetes outpatient clinic at the Dr. Soetomo General Academic Hospital from August to October 2023. Data regarding sociodemographics, medication, glycosylated hemoglobin (HbA1c), lipid profiles, and FibroScan with controlled attenuation parameter (CAP) were collected from all participants. The group with hepatic steatosis (CAP≥237 dB/m) had a higher body mass index (BMI), higher TG levels, and TG/HDL-C ratio values. The TG/HDL-C ratio was significantly correlated with CAP values. Hepatic steatosis can be identified using the TG/HDL-C ratio with a cut-off value of 2.83 (sensitivity:72.4%; specificity:71.4%). An elevated TG/HDL-C ratio is associated with a higher risk (OR:6.562; p<0.05) of having hepatic steatosis. The TG/HDL-C ratio is a potential marker to predict NAFLD in T2DM patients.

THU349 Association Of Non-alcoholic Fatty Liver Disease And Type 2 Diabetes Mellitus - A Cross-Sectional Study

Abstract Disclosure: M. Parvez: None. U.K. Patel: None. Introduction: Nonalcoholic fatty liver disease (NAFLD) and Type 2 diabetes mellitus (T2DM) commonly exist together and have been regarded as a manifestation of metabolic syndrome. But there are limited studies showing prevalence and association of NAFLD with T2DM patients in US populations. Aims and Objective: Primary outcome of the study was to identify the prevalence and association of NAFLD amongst patients with T2DM amongst the US populations. Methods: A cross-sectional study was performed using the National Health and Nutrition Examination Survey database from 2015 to 2018. Adults with diagnosis of NAFLD and non-NAFLD were identified. We ran univariate analysis using Mann Whitney U test and chi-square test. Multivariable survey logistic regression analysis was performed to find out the association between NAFLD and T2DM. Results: Out of a total 275,968 people, 0.26% had NAFLD. Older population (median: 62 years), male, Mexican American, and people with median household income >$100,000 had a higher prevalence of NAFLD. The diagnosis of NAFLD (40.31% vs 14.23%; p<0.0001) was more prevalent amongst patients with T2DM in comparison to those without NAFLD. In regression analysis, T2DM patients had significantly higher odds of having NAFLD (aOR: 10.40, 95%CI: 10.37- 10.42, p<.0001, c=0.736). Conclusion: Long term follow-up, early identification, and prompt treatment may mitigate the burden of NAFLD in T2DM patients. Presentation: Thursday, June 15, 2023

Prevalence of nonalcoholic fatty liver disease in type 2 diabetes mellitus patients from the Eastern region of India

ObjectiveThe risk of nonalcoholic fatty liver disease (NAFLD) is increased significantly in individuals having Type 2 diabetes mellitus (T2DM) and the presence of T2DM enormously drives NAFLD progression. However, in clinical practice, it is overlooked despite the significant clinical effects of NAFLD in T2DM. Our study aimed to estimate the prevalence of NAFLD in T2DM patients from the eastern region of India. MethodsThis cross-sectional study assessed 132 T2DM patients for NAFLD. Anthropometry and lipid estimations were done in all the individuals. Hepatic fibrosis was diagnosed by transient elastography (TE) using a TOUCH 502 Fiber Scanner using M‑probe. A fibrosis score ≥ 11 kgpascals (kPa) was used to define advanced fibrosis (F3). ResultsOverall prevalence of NAFLD in T2DM patients was 57% (75/132 subjects) and the prevalence is higher in males (54.6%). Results showed that approximately 26% of patients with NAFLD will develop into NASH, among them 37.3% developed mild to moderate steatosis and 26.6% developed severe steatosis. ConclusionThe prevalence of NAFLD is high in the eastern region of India, need for early diagnosis and treatment of NAFLD in T2DM. The use of TE with other serum markers can be helpful for the diagnosis of advanced fibrosis.

Diagnostic Performance of Greyscale Ultrasound in Detecting Fatty Liver Disease in a Type 2 Diabetes Population Using FibroScan as the Reference Standard.

Introduction Brightness mode ultrasound (B-mode US) and FibroScan (Echosens, Paris, France) are the two ultrasound methods often recommended for screening non-alcoholic fatty liver disease (NAFLD) in persons with type 2 diabetes mellitus (T2DM). This study assessed the diagnostic performance of B-mode US using FibroScan as the reference standard. Methods Persons with a known history of T2DM were invited to screen for NAFLD using B-mode US and FibroScan on separate days within a one-month period. Assessors of B-mode US and FibroScan were blinded to each other's findings. Both B-mode US and FibroScan independently assessed and graded each participant for the presence of NAFLD. Using the diagnostic test findings of FibroScan as a reference standard, the sensitivity and specificity of B-mode US were analyzed.The area under the receiver operating characteristic curve (AUROC) was analyzed using Jamovi (version 2.3.21). A multinomial logistic regression of the B-mode US and FibroScan in predicting NAFLD grade was also analyzed. Results A total of 171 participants were assessed. B-mode US detected NAFLD in T2DM patients with 63.6% sensitivity, 65.6% specificity, and 0.646 AUROC. Sensitivity and specificity in overweight and obese participants were 36-43% and 76-85%, respectively. Multinomial logistic regression demonstrated an insignificant statistical relationship between FibroScan and B-mode US in predicting grade 1 steatosis (p-value = 0.397), which was significantly affected by a higher BMI (p-value = 0.034) rather than a higher liver fibrosis level (p-value = 0.941). The logistic regression further showed a significant relationship between B-mode US and FibroScan in predicting steatosis grade 2 (p-value = 0.045) and grade 3 (p-value < 0.001), which was not significantly affected by BMI (p-value = 0.091). Conclusion B-mode US can replace FibroScan for severe steatosis; however, it cannot be used to screen for NAFLD in T2DM patients due to lower sensitivity for early detection in the overweight.

Serum C1q/TNF-Related Protein 4 Levels are Associated with Nonalcoholic Fatty Liver Disease in Type 2 Diabetic Patients.

Introduction: There is a strong bidirectional relationship between nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM), both of which can lead to an increase in harmful metabolism and cardiovascular risk. It was discovered that C1q/TNF-related protein 4 (CTRP4) regulates glucolipid metabolism and feeding behavior. However, the correlation between serum CTRP4 and NAFLD in T2DM patients is not yet fully understood. Methods: This study enrolled 188 T2DM participants who were separated into 2 distinct groups (NAFLD and non-NAFLD) according to abdominal ultrasound imaging results. The enzyme-linked immunosorbent assay was utilized to evaluate the levels of serum CTRP4. Clinical data and CTRP4 concentration were compared between the two groups. Linear and logistic regression analyses were performed to evaluate the correlation of serum CTRP4 levels with NAFLD risk in T2DM patients. Results: Compared with non-NAFLD, the concentration of CTRP4 was lower in NAFLD group (median 2.46 vs. 2.89, P < 0.001). The log(CTRP4) value was found to be negatively correlated with alanine aminotransferase, aspartate aminotransferase, body mass index (BMI), and waist circumference in a Pearson correlation analyses (r = -0.159, -0.156, -0.224, -0.268, all P < 0.05); besides, the trend χ2 test demonstrated that the prevalence of NAFLD rose as CTRP4 concentration decreased (P < 0.001). Regression analysis suggested that NAFLD served as an independent factor influencing log(CTRP4) independently (β-coefficient = -0.12, P = 0.011), even after adjusting for high-sensitivity C-reactive protein and white blood cells. Finally, the results of the logistic regression analysis demonstrated that BMI [odds ratio (OR) = 1.196, P = 0.028], triglyceride (OR = 2.744, P < 0.001), and CTRP4 (OR = 0.615, P = 0.032) were independently associated with NAFLD in T2DM. Conclusions: T2DM patients with NAFLD have lower CTRP4 serum concentrations than those without NAFLD. The risk of NAFLD in patients with T2DM is inversely correlated with serum CTRP4 levels.

Liraglutide on type 2 diabetes mellitus with nonalcoholic fatty liver disease: A systematic review and meta-analysis of 16 RCTs.

Nonalcoholic fatty liver disease (NAFLD) is a common comorbidity of type 2 diabetes mellitus (T2DM). Our aim is to investigate the effects of liraglutide on T2DM with NAFLD. Relevant articles published from the earliest publication to March 2022 were selected from several databases. The Cochrane Collaboration's RevMan software was used for the analysis. Sixteen studies are selected for this meta-analysis, which includes totally 634 patients in the treatment group and 630 patients in the control group. As a result, 14 studies show that fasting plasma glucose levels of the experimental group are lower than that of the control group; 15 studies show that glycosylated hemoglobin A1c levels of the experimental group are lower than that of the control group; 13 studies show that triglyceride levels of the experimental group are lower than that of the control group; twelve studies show that total cholesterol levels of the experimental group are lower than that of the control group; 10 studies show that alanine aminotransferase levels of the experimental group is lower than that of the control group; 10 studies show that no significant difference in changes in aspartate transaminase between 2 groups; 13 studies show that low density lipoprotein cholesterol levels of the experimental group is lower than that of the control group; 9 studies show that no significant difference in changes in high density lipoprotein cholesterol between 2 groups; 7 studies mentioned adverse effects and the difference is significant. Liraglutide is potentially curative for T2DM with NAFLD.

Correlation between Liver Fat Indices and Ultrasonography to Determine Non-alcoholic Fatty Liver Disease among Diabetic Patients in Sri Lanka

Objectives: Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) strongly coexist as they share common pathophysiological conditions. Several non-invasive, patient-friendly, and cost-effective liver fat indices have been introduced recently to diagnose NAFLD at an early stage. This study aimed to establish the correlation between ultrasonography and liver fat indices (fatty liver index [FLI] and hepatic steatosis index [HSI]) to determine NAFLD among known T2DM patients. Material and Methods: A cross-sectional study was conducted using one hundred newly diagnosed type 2 diabetic patients attending the diabetic and endocrinology clinic at the Colombo South Teaching Hospital, Kalubowila, Sri Lanka. An interviewer-administered questionnaire was used to collect socio-demographic data and anthropometric measurements. Ultrasound scans were performed to diagnose and stage fatty liver. Biochemical investigations included aspartate amino transferase, alanine aminotransferase, gamma-glutamyl transferase triglyceride analysis. Scores for the liver fat indices were calculated using collected data and correlations between the variables were statistically analysed using the statistical software, SPSS version 23.0. Descriptive statistics, chi-square tests, Independent t-tests and Pearson correlation were used in the data analysis. Results: The incidence of NAFLD among T2DM was 82%. There was a statistically significant correlation (P &lt; 0.05) between NAFLD diagnosed by ultrasonography and HSI. There was also a statistically significant correlation (P &lt; 0.001) between NAFLD diagnosed by ultrasonography and FLI, and there was a statistically significant difference between FLI among participants with no fatty liver compared to participants with ≥ grade 2 fatty liver (P &lt; 0.001. Conclusion: The current study showed that both FLI and HSI can be used as markers for the early diagnosis of NAFLD in T2DM patients.

A Cross-Sectional Study of the Correlation Between the Atherogenic Index of Plasma and Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes.

PurposeThe main objective of this study was to examine the possible association between the atherogenic index of plasma (AIP) and the prevalence of nonalcoholic fatty liver disease (NAFLD) in Chinese individuals with type 2 diabetes mellitus (T2DM).Patients and methodsIn this survey, data from 1074 patients with T2DM were retrospectively extracted. The correlations between each variable and NAFLD were determined by univariate analysis, and then, the statistically significant variables were evaluated for their association with AIP and NAFLD by multivariate regression analysis.ResultsAIP levels were significantly higher in all males and females with NAFLD than those without NAFLD (p<0.001). The prevalence of NAFLD increased progressively throughout the AIP quartiles (trend P < 0.001) and accounted for possible variables in Model 3 of the multivariate logistic regression analysis (OR: 2244.984). In terms of sensitivity and specificity, the AIP index was found to be 65.0% and 90.1% accurate, respectively, with a 95% CI of 0.804–0.893. According to a stratified analysis, females, patients over the age of 56 and current nonsmokers were found to have a higher chance of developing NAFLD.ConclusionT2DM individuals with NAFLD were found to have a higher AIP index than those without NAFLD. The prevalence and progression of NAFLD in T2DM patients may be influenced by the AIP index.

Correlation between the thyroid hormone levels and nonalcoholic fatty liver disease in type 2 diabetic patients with normal thyroid function

BackgroundThe objective of this study is to retrospectively analyze the correlation between the thyroid hormones and nonalcoholic fatty liver disease (NAFLD) in type 2 diabetes mellitus (T2DM) patients with normal thyroid function. Methods: Totally 586 T2DM patients with normal thyroid function participated in this research and were divided into T2DM without NAFLD (240 cases) group and T2DM with NAFLD (346 cases) group. The NAFLD fibrosis score (NFS) > 0.676 was defined as progressive liver fibrosis and used to categorize the patients into T2DM without progressive liver fibrosis group (493 cases) and T2DM with progressive liver fibrosis group (93 cases). Results: The results indicated that the levels of free triiodothyronine (FT3), total triiodomethylamine (TT3) and FT3/free thyroxine ratio (FT3/FT4) were significantly higher while the FT4 level was lower in T2DM with NAFLD group than that in T2DM without NAFLD group (p < 0.05). The levels of FT3, FT4, TT3 and TT4 in patients with progressive liver fibrosis were significantly lower in patients with progressive liver fibrosis than that in patients without progressive liver fibrosis (p < 0.05). Logistic regression analysis showed a positive connection between FT3/FT4 ratio and NAFLD (p = 0.038), a negative relationship between FT4 level and NAFLD (p = 0.026), between the levels of FT4, TT3 and total thyroxine (TT4) and the risk of progressive hepatic fibrosis (p = 0.022, p = 0.007, p = 0.046).ConclusionThere is a certain correlation between thyroid hormone levels and NAFLD in T2DM patients, suggesting that the assessment of thyroid hormone levels in T2DM patients with normal thyroid function could be helpful in the prevention and treatment of NAFLD.

Clinico-pathological features and related risk factors of Type-2 diabetes mellitus complicated with nonalcoholic fatty liver.

Objectives:To analyze the clinicopathological features and risk factors of Type-2 diabetes mellitus (T2DM) patients with non-alcoholic fatty liver disease (NAFLD).Methods:The data of 145 patients with T2DM who received treatment in our hospital from May 2020 to May 2021 were collected. The patients were diagnosed with NAFLD by abdominal liver Doppler ultrasound; The general data and laboratory examination indexes of T2DM patients with and without NAFLD were compared; To analyze the risk factors of NAFLD in T2DM patients.Results:According to the results of the ultrasound examination, 71(48.97%) patients were simple T2DM, and 74(51.03%) patients were T2DM with NAFLD. Compared with simple T2DM, T2DM patients with NAFLD had higher BMI, hypertension, fasting plasma glucose(FPG), insulin resistance, triglycerides (TG), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and uric acid(UA) (P<0.05). Further logistic regression analysis showed a higher BMI (OR=1.841, P=0.013), FPG (OR=1.576, P=0.014), insulin resistance (OR=4.195, P<0.001) and elevated TG (OR=4.676, P=0.042) are risk factors for T2DM with NAFLD.Conclusion:High BMI, BPG, insulin resistance index and TG are independent risk factors for nonalcoholic fatty liver in T2DM patients. During intervention, attention should be paid to the monitoring of these indicators to effectively prevent the aggravation of the disease.

Serum Retinol-Binding Protein Levels Are Associated with Nonalcoholic Fatty Liver Disease in Chinese Patients with Type 2 Diabetes Mellitus: A Real-World Study.

Background The association of serum retinol-binding protein (RBP) levels with nonalcoholic fatty liver disease (NAFLD) remains controversial. Furthermore, few studies have investigated their relationship in type 2 diabetes mellitus (T2DM) patients. Therefore, the aim of the present study was to explore the association between serum RBP levels and NAFLD in Chinese inpatients with T2DM.Methods This cross-sectional, real-world study included 2,263 Chinese T2DM inpatients. NAFLD was diagnosed by abdominal ultrasonography. The subjects were divided into four groups based on RBP quartiles, and clinical characteristics were compared among the four groups. The associations of both RBP levels and quartiles with the presence of NAFLD were also analyzed.Results After adjustment for sex, age, and diabetes duration, there was a significant increase in the prevalence of NAFLD from the lowest to the highest RBP quartiles (30.4%, 40.0%, 42.4%, and 44.7% for the first, second, third, and fourth quartiles, respectively, P<0.001 for trend). Fully adjusted multiple logistic regression analysis revealed that both increased RBP levels (odds ratio, 1.155; 95% confidence interval, 1.012 to 1.318; P=0.033) and quartiles (P=0.014 for trend) were independently associated with the presence of NAFLD in T2DM patients.Conclusion Increased serum RBP levels were independently associated with the presence of NAFLD in Chinese T2DM inpatients. Serum RBP levels may be used as one of the indicators to assess the risk of NAFLD in T2DM patients.

Diabetes Mellitus and Non-Alcoholic Fatty Liver Disease: Diagnosis and Treatment

The prevalence of non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of metabolic syndrome, is rapidly increasing in Korean populations and is estimated to reach 39% among Korean adults. NAFLD is one of the strongest risk factors of type 2 diabetes mellitus (T2DM), and the presence of NAFLD in T2DM patients is associated with a worse natural course of diabetic complications. The gold standard for diagnosing NAFLD is liver biopsy, which involves sampling error, high cost, and other disadvantages related to its invasive nature. We summarize non-invasive diagnostic NAFLD algorithms including biomarkers and four major imaging tools (ultrasonography, computed tomography, magnetic resonance imaging, and liver FibroScanⓇ) for diagnosing NAFLD including hepatic fibrosis. To prevent NASH (nonalcoholic steatohepatitis) or liver fibrosis, a combination of lifestyle modification with a low caloric diet and exercise, anti-diabetic agents, and non-anti-diabetic agents should be applied.

Prevalence and risk factor analysis for the nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus.

Although non-alcoholic fatty liver disease (NAFLD) is strongly associated with type 2 diabetes mellitus (T2DM), the diagnosis of NAFLD for T2DM patients remains a challenge.This study aimed to investigate the prevalence and risk factors for the NAFLD in T2DM outpatients.This is a retrospective, cross-sectional study that included 2405 T2DM patients treated and admitted for glucose control into the Endocrinology Department of our hospital from April 2017 to March 2019. Using strict exclusion criteria, the target patients were screened and divided into two groups: NAFLD patients (study group) and non-NAFLD patients (control group). Subsequently, 34 factors were compared between the two groups. Furthermore, multivariate analysis of the NAFLD risk factors was performed using logistic regression. Finally, the diagnostic significance of individual biochemical predictors, as well as the combined predictive indicator (CPI), for NAFLD was estimated using receiver operating characteristic (ROC) curve analysis.In this study, the overall prevalence of NAFLD in T2DM patients was 58.67%. Of the target patients, 17 factors were identified by univariate analysis to be associated with NAFLD, and 8 factors were found to be significant predictors for NAFLD using binary logistic regression modeling. Furthermore, the CPI and C-Peptide represent high diagnostic value for NAFLD in T2DM patients.This study provides a more comprehensive risk factor analysis for NAFLD in T2DM patients. These data can be used to provide timely diagnosis and effective management of NAFLD.

Liraglutide Alleviates Hepatic Steatosis and Liver Injury in T2MD Rats via a GLP-1R Dependent AMPK Pathway.

Non-alcoholic fatty liver disease (NAFLD), ranging from non-alcoholic fatty liver to non-alcoholic steatohepatitis, can be prevalent in patients with type 2 diabetes mellitus (T2DM). However, no antidiabetic drug has been approved for the treatment of NAFLD in T2DM patients. Multiple daily injections of basal-bolus insulin are often the final therapeutic option for T2DM. We found that insulin treatment aggravated hepatic steatosis and oxidative stress in Zucker diabetic fatty (ZDF) rats. In addition to glycaemic control, we demonstrated the stimulatory role of liraglutide in relieving hepatic steatosis and liver injury in ZDF rats. Interestingly, liraglutide could also alleviate insulin-aggravated hepatic fatty accumulation. The glucagon-like peptide-1 (GLP-1) agonists liraglutide and Ex-4 activated the expression of peroxisome proliferator-activated receptor alpha (PPARα) via a GLP-1 receptor-dependent 5′ AMP-activated protein kinase pathway. As a nuclear transcription factor, PPARα could mediate the effect of GLP-1 in alleviating hepatic steatosis by differentially regulating the expression of its target genes, including acetyl CoA carboxylase and carnitine palmitoyl transferase la both in vitro and in vivo. Moreover, GLP-1 could relieve liver injury by decreasing oxidative stress stimulated by hepatic steatosis. Insulin might aggravate hepatic steatosis and liver injury by inhibiting GLP-1R expression. The findings indicate the feasibility of liraglutide treatment combined with basal insulin in attenuating hepatic steatosis and liver injury in ZDF rats. This knowledge, and the evidence for the underlying mechanism, provide a theoretical basis for the combination treatment recommended by the latest clinical practice guidelines for T2DM.

Prevalence and Clinical Characteristics of Nonalcoholic Liver Disease in Type 2 Diabetes Mellitus Patients: A Cross-sectional Study

Introduction: A refined diagnostic and classification strategy incorporating phenotypic characteristics of patients with Type 2 Diabetes Mellitus (T2DM) along with their blood glucose profile, lipid levels and evidence of Nonalcoholic Fatty Liver Disease (NAFLD) will help in identifying high risk population. Aim: To determine the prevalence and assess the clinical characteristics of NAFLD in T2DM patients from August 2016 to February 2017. Materials and Methods: This cross-sectional analysis was conducted on 100 T2DM patients with no history of alcohol intake, at the time of their screening. Physical examination and anthropometric measurements such as Body Mass Index (BMI) and Waist to Hip Ratio (WHR) were calculated. Fasting Blood Glucose (FBG), Post-Prandial Blood Glucose (PPBG), glycated haemoglobin (HbA1c), serum bilirubin, liver enzymes, lipid profile and ultrasound of the abdomen to diagnose NAFLD were done. Statistical analysis was carried out using student’s t-test and Statistical Package for the Social Sciences (SPSS) Version 19. Results: The prevalence of NAFLD in T2DM patients was 52%. The mean age was 52.27±1.82 years, with 40% males in the study cohort. There was a significant statistical correlation between the higher BMI (p&lt;0.001), higher WHR (p=0.046), prevalence of upper body obesity (p&lt;0.001) and the presence of NAFLD. The glycaemic control was poorer in patients with NAFLD with higher FBG (p=0.0027), PPBG (p=0.0027) and HbA1c p&lt;0.001) than the non-NAFLD group. The serum cholesterol, triglycerides, Serum Glutamic Pyruvic Transaminase (SGPT), Serum Glutamic Oxaloacetic Transaminase (SGOT) were significantly higher in the NAFLD group. Duration of diabetes was not significantly different among the groups. Conclusion: The incidence of NAFLD is common in T2DM patients with poor glycaemic control, dyslipidaemia, and obesity being associated factors. Duration of diabetes is not a significant predictor of NAFLD.

Nonalcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus: A Bidirectional Relationship.

Worldwide, the leading cause of chronic liver disease is represented by nonalcoholic fatty liver disease (NAFLD) which has now become a global epidemic of the 21st century, affecting 1 in 4 adults, and which appears to be associated with the steadily increasing rates of metabolic syndrome and its components (obesity, type 2 diabetes mellitus (T2DM), and dyslipidemia). NAFLD has been reported to be associated with extrahepatic manifestations such as cardiovascular disease, T2DM, chronic kidney disease, extrahepatic malignancies (e.g., colorectal cancer), endocrine diseases (e.g., hypothyroidism, polycystic ovarian syndrome, psoriasis, and osteoporosis), obstructive sleep apnea, and iron overload. The prevalence of NAFLD is very high, affecting 25–30% of the world population and encloses two steps: (1) nonalcoholic fatty liver (NAFL), which includes steatosis only, and (2) nonalcoholic steatohepatitis (NASH) defined by the presence of steatosis and inflammation with hepatocyte ballooning, with or without fibrosis which can progress to liver fibrosis, hepatocellular carcinoma, and liver transplantation. Current data define a more complex relationship between NAFLD and T2DM than was previously believed, underlining a bidirectional and mutual association between the two entities. This review aims to summarize the current literature regarding the incidence of T2DM among patients with NAFLD and also the prevalence of NAFLD in T2DM patients, highlighting the recent key studies. Clinicians should screen, diagnose, and treat T2DM in patients with NAFLD in order to avoid short- and long-term complications.

Association between Thyroid Function and Nonalcoholic Fatty Liver Disease in Euthyroid Type 2 Diabetes Patients.

Thyroid function and type 2 diabetes mellitus (T2DM) are both associated with increased risks of adverse clinical outcomes in nonalcoholic fatty liver disease (NAFLD). Our study is aimed at evaluating the association between thyroid function and NAFLD in T2DM patients with normal thyroid function (euthyroid) and analyzing the potential effects of metformin on the pathological process. Overall, 369 T2DM patients were enrolled between July 2017 and September 2018 and stratified into NAFLD and non-NAFLD groups. Data on age, gender, body mass index (BMI, kg/m2), metformin use, and basal metabolic rate (BMR) were obtained from participants' records. All patients were tested for biochemical markers, indexes of glucose metabolism, lipid metabolism, bone metabolism, and thyroid function at baseline. Multivariate analyses detected increased odds of NAFLD among individuals with T2DM per unit increase in their BMI and free triiodothyronine (FT3) and thyroid stimulating hormone (TSH); the odds ratios (OR) were 1.25, 3.02, and 1.58, respectively (all p < 0.05). Positive correlations were detected between alanine aminotransferase (ALT) and FT3 (r = 0.221, p = 0.010), and negative correlations were noted between TSH and BMR (r = −0.618, p < 0.001) and between BMR and FT3 (r = −0.452, p < 0.001) in T2DM subjects with NAFLD. A significant difference in serum FT3 (t = 2.468, p = 0.0167) and TSH (t = 2.658, p = 0.010) levels was found between obese individuals with NAFLD who used and did not use metformin. The pathological mechanism of T2DM complicated by NAFLD in euthyroid patients may be associated with insulin resistance and a thyroid hormone resistance-like manifestation, i.e., relevant hypothyroidism. Metformin can potentially decrease the double-resistance situation, especially in obese individuals.

Establishment of a Risk Prediction Model for Non-alcoholic Fatty Liver Disease in Type 2 Diabetes

IntroductionNon-alcoholic fatty liver disease (NAFLD) is becoming more prevalent in patients with type 2 diabetes mellitus (T2DM) and can contribute to serious liver damage in this patient population. The aim of this study was to develop a risk nomogram for NAFLD in a Chinese population with T2DM.MethodsA questionnaire survey, physical examination and biochemical indicator testing were performed on 874 patients with T2DM, and the collected data were used to evaluate the risk to develop NAFLD in T2DM patients. The least absolute shrinkage and selection operator (LASSO) regression analysis method was used to optimize variable selection by running cyclic coordinate descent with k-fold (tenfold in this case) cross-validation. Multivariable logistic regression analysis was applied to build a predictive model by introducing the predictors selected from the LASSO regression analysis. The nomogram was developed based on the selected variables visually. A calibration plot, receiver operating characteristic curve (ROC) and decision curve analysis (DCA) were used to validate the model, with further assessment by external validation.ResultsA total of nine predictors, namely sex, age, total cholesterol (TC), body mass index (BMI), waistline, diastolic blood pressure (DBP), serum uric acid (SUA), course of disease and high-density lipoprotein-cholesterol (HDL-C), were identified by LASSO regression analysis from a total of 24 variables studied. The model constructed using these nine predictors displayed medium prediction ability, with an area under the ROC of 0.848 in the training set and 0.809 in the validation set. The DCA curve showed that the nomogram could be applied clinically if the risk threshold was between 48 and 91%, which was found to be between 44 and 82% in the external validation.ConclusionIntroducing sex, age, TC, BMI, waistline, DBP, SUA, course of disease and HDL-C into the risk nomogram increased its usefulness for predicting NAFLD risk in patients with T2DM.

Non-Alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes: Evaluation of Hepatic Fibrosis and Steatosis Using Fibroscan.

Patients with type 2 diabetes mellitus (T2DM) are at increased risk of non-alcoholic fatty liver disease (NAFLD) and might eventually progress to advanced fibrosis, cirrhosis and hepatocellular carcinoma (HCC). Recommendations on whether to screen for NAFLD in diabetic patients remains conflicted between major guidelines. Transient elastography using FibroScan with CAP (controlled attenuation parameter) can assess both liver steatosis and fibrosis simultaneously. This paper took a new look at the prevalence of NAFLD and the severity of fibrosis among T2DM patients in Vietnam. The study was conducted using a cross-sectional design in T2DM adults who attended Dai Phuoc Ho Chi Minh Polyclinic and Polyclinic of Pham Ngoc Thach University of Medicine. Liver steatosis and fibrosis was assessed by FibroScan. NAFLD was diagnosed if CAP > 233 dB/m (steatosis > 5%). Data were analyzed using STATA 12 software program. We found that a total of 307 type 2 diabetic patients qualified for the study’s criteria. The prevalence of NAFLD in T2DM patients based on FibroScan was 73.3%. Rates of mild, moderate and severe steatosis were 20.5%, 21.8% and 30.9%, respectively. The prevalence of significant fibrosis (≥ F2), advanced fibrosis (≥ F3) and cirrhosis (F4) was 13.0%, 5.9% and 3.6%, respectively. On multivariate analysis, aspartate aminotransferase (AST) (OR: 1.067; 95% CI: 1.017–1.119; p = 0.008) and platelet levels (OR: 0.985; 95% CI: 0.972–0.999; p = 0.034) were independent of risk factors of advanced fibrosis. Thus, our study supports screening for NAFLD and for evaluating the severity of liver fibrosis in T2DM patients.

Plasma miR-513a-5p as a Potential Biomarker for Diagnosis of Nonalcoholic Fatty Liver Disease in Type 2 Diabetes Mellitus Patients

The current study aims to investigate the relationship between plasma levels of miR-513a-5p and lipid metabolism and insulin resistance in patients with type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD). Two hundred patients with T2DM were selected, including 104 patients with NAFLD diagnosed by ultrasound and 96 patients without NAFLD. They were divided into combined group (T2DM/NAFLD) and control group (T2DM). Height, weight, blood lipid, and blood sugar were measured. Additionally, body mass index (BMI) and homeostasis model assessment of insulin resistance (HOMA-IR) index were calculated. RT-PCR was carried out to analyze the level of plasma miR-513a-5p. The correlation between plasma miR-513a-5p level and clinical indicators was analyzed by Pearson's correlation assay. Compared with the T2DM group, BMI, AST, ALT, TG, GGT, LDL-C, 2hPBG, Fins, 2hIns, HbAIc (%), and HOMA-IR were significantly increased in the T2DM/NAFLD group, and plasma miR-513a-5p levels were significantly decreased. Pearson's correlation analysis showed that miR-513a-5p was negatively correlated with ALT, LDL-C, 2h Ins, and HomA-IR. Receiver operating characteristic (ROC) analysis showed plasma miR-513a-5p could differentiate T2DM/NAFLD patients from NAFLD patients. Decreased plasma miR-513a-5p level may act as a potential biomarker for diagnosis of NAFLD in T2DM patients.