Non-alcoholic Fatty Liver Disease (NAFLD) and Significant Hepatic Fibrosis Defined by Non-invasive Assessment in Patients with Type 2 Diabetes


Background: Non-alcoholic fatty liver disease (NAFLD), the most common liver problem in diabetes, is arisk factor for liver cancer. Diabetes, high body mass index (BMI) and old age can all contribute to NAFLDprogression. Transient elastography (TE) is used for non-invasive fibrosis assessment.
Objectives: To identifythe prevalence of NAFLD and significant hepatic fibrosis in diabetic patients and to assess associated factors.Materials and
Methods: One hundred and forty-one diabetic and 60 normal subjects were screened. Fatty liverwas diagnosed when increased hepatic echogenicity and vascular blunting were detected by ultrasonography.Liver stiffness measurement (LSM) representing hepatic fibrosis was assessed by TE. LSM ≥7 kPa was used todefine significant hepatic fibrosis.
Results: Four cases were excluded due to positive hepatitis B viral markersand failed TE. Diabetic patients had higher BMI, systolic blood pressure, waist circumference and fasting glucoselevels than normal subjects. Fatty liver was diagnosed in 82 (60.7%) diabetic patients but in none of the normalgroup. BMI (OR: 1.31; 95%CI: 1.02-1.69; p=0.038) and alanine aminotransferase (ALT)(OR: 1.14; 95%CI:1.05-1.23; p=0.002) were associated with NAFLD. Diabetic patients with NAFLD had higher LSM than thosewithout [5.99 (2.4) vs 4.76 (2.7) kPa, p=0.005)]. Significant hepatic fibrosis was more common in diabetic patientsthan in normal subjects [22 (16.1%) vs 1 (1.7%), p=0.002]. Aspartate aminotransferase (AST)(OR: 1.24; 95%CI:1.07-1.42; p=0.003) was associated with significant hepatic fibrosis.
Conclusions: Sixty and sixteen percent ofdiabetic patients were found to have NAFLD and significant hepatic fibrosis. High BMI and ALT levels are thepredictors of NAFLD, and elevated AST level is associated with significant hepatic fibrosis.