DOI: http://dx.doi.org/10.18203/2349-3933.ijam20173229

Magnitude of nonalcoholic fatty liver disease (NAFLD) and concomitant risk factors in patients with type 2 diabetes mellitus

Mayank Gupta, Mahavar S., Chaturvedi A., Chandra R., Chauhan G., Srivastava S., Sharma R.

Abstract


Background: Non-alcoholic fatty liver disease (NAFLD) is a distinct hepatic condition that is strongly associated with insulin resistance and type 2 Diabetes Mellitus (T2DM). This study was designed to assess the magnitude of NAFLD and its concomitant risk factors among patients with T2DM.

Methods: In a hospital based observational descriptive study, 150 patients with T2DM were submitted to a complete clinical and laboratory evaluation; abdominal ultrasonography for NAFLD detection and grading. Patients with known chronic liver disease and history of alcohol intake were excluded. They were divided into fatty and non-fatty liver group: evaluated, compared and statistical analysis done.

Results: Out of 150 patients with T2DM, 104 (69.33%) had fatty liver on USG. 42.67% had grade 1, 24% had grade 2, and the remaining 2.67% had grade 3 fatty changes in liver. The severity of NAFLD increased with increasing age (r-value = +0.554, p<0.001). Statistically significant difference in Body Mass Index (29.64±4.36 v/s 25.94±3.25 kg/m2, p<0.001) and triglycerides (175.47±24.82 v/s 128.53±26.66 mg/dl, p<0.001) was observed in the fatty liver group as compared to non-fatty liver group.

Conclusions: The magnitude of NAFLD is higher in type 2 diabetic patients. Older age group, Body Mass Index (BMI) and triglyceride (TG) had significant relationship with the presence of fatty liver. Ultrasonographic evidence of fatty liver with older age, elevation of triglyceride level and increasing BMI should be taken seriously as a predictor of severity of NAFLD.


Keywords


Age, BMI, NAFLD, T2DM, Triglycerides

Full Text:

PDF

References


Afkhami Ardakani M, Rashidi M. Risk factors of type 2 diabetes. J Rafsanjan University Med Sci. 2005;4(4):348-65.

Farrell GC, Larter CZ. Non-alcoholic fatty liver disease: from steatosis to cirrhosis hepatology 2006;43:S00-S112.

Duseja A, Non-alcoholic fatty liver disease in India: a lot done, yet more required. Indian J Gastroenterol. 2010;29:217-25.

Singh SP, Nayak S, Swain M, et al. Prevalence of non alcoholic fatty liver disease in coastal eastern India: a preliminary ultrsonographic survey. Trop Gastroenterol. 2004;25:76-9.

Gupte P, Amarapurkar D, Agal S, et al. Non-alcoholic steatohepatitis in type 2 diabetes mellitus. J Gastroenterol Hepatol. 2004;19:854-58.

Amarapurkar D, Kamani P, Patel N, Gupte P, Kumar P, Agal S, et al, Prevalence of non-alcoholic fatty liver disease: population based study. Ann Hepatol. 2007;6:161-3.

Mohan V, Farooq S, Deepa M, Ravikumar R, Pitchumoni CS. Prevalence of non-alcoholic fatty liver disease in urban south Indians in relation to different grades of glucose intolerance and metabolic syndrome. Diabetes Res Clin Pract. 2009;84:84-91.

Uchil D, Pipalia D, Chawla M, Patel R, Maniar S, Narayani, Juneja A. Non-alcoholic fatty liver disease (NAFLD)-the hepatic component of metabolic syndrome. J Assoc Physicians India. 2009;57:201-4.

Prashanth M, Ganesh HK, Vima MV, John M, Bandgar T, Joshi SR, et al. Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus. J Assoc Physicians India. 2009;57:205-10.

Marchesini G, Bugianesi E, Forlani G, Cerrelli F, Lenzi M, Manini R, et al, Non-alcoholic fatty liver, steatohepatitis, and the metabolic syndrome, Hepatol. 2003;37(4):917-23.

Hamaguchi M, Kojima T, Takeda N et al. The metabolic syndrome as a predictor of non-alcoholic fatty liver disease. Ann. Intern. Med. 2005;143:722-816.

El Hassan AY, Ibrahim EM, al-Mulhim FA, Nabhan AA, Chammas MY. Fatty infiltration of the liver: analysis of prevalence, radiological and clinical features and influence on patient management. Br J Radiol. 1992;65:774-8.

James OF, Day CP. Non-alcoholic steatohepatitis (NASH): a disease of emerging identity and importance. J Hepatol. 1998;29:495-501.

Saverymuttu SH, Joseph AE, Maxwell JD. Ultrasound scanning in the detection of hepatic fibrosis and steatosis. BMJ 1986;292:13-15.

Angulo P, Keach JC, Batts KP, Lindor KD, Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatol. 1999;30:1356-62.

Younossi ZM, Gramlich T, Matteoni CA, et al., Non-alcoholic fatty liver disease in patients with type 2 diabetes. Clin Gastroenterol Hepatol. 2004;2:262-5.

Bugianesi E, Vanni E, Marchesini G, NASH and the risk of cirrhosis and hepatocellular carcinoma in type 2 diabetes, Current Diabetes Reports. 2007;7:175-80.

Younossi ZM, Gramlich T, Matteoni CA, et al., Nonalcoholic fatty liver disease in patients with type 2 diabetes, Clin Gastroenterol Hepatol. 2004;2:262-5.

National institute of health (NIH), National Heart, Lung, and Blood Institute (NHLBI). The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. Bethesda: National Institute of Health. 2000, NIH publication 00-4084.

Diagnosis and classification of diabetes mellitus. Diabetes Care (American Diabetes Association). 33 Suppl 1 (Supplement_1). 2010:S62–9.

Sanjay Kalra, Manoj Vithalani, Gurjeet Gulati, CM Kulkarni, Yoge Kadam, James Pet al. Study of Prevalence of NAFLD in type 2 DM in India (SPRINT) 2013;61:448-53.

Shivaram Prasad Singh, Ayaskanta Singh, Girish Kumar Pati, Bijay Misra, Debasis Misra, Sanjib Kumar Kar, et al. A study of prevalence of diabetes and prediabetes in patients of non-alcoholic fatty liver disease and the impact of diabetes on liver histology in coastal eastern India. J Diabetes Mellitus. 2014;4:290-96.

Clark JM, Brancati FL, et al. Non-alcoholic fatty liver disease. Gastroenterol. 2002;122:1649-57.

George Boon-Bee Goh, Mangesh R. Pagadala, Jaividhya Dasarathy, Aynur Unalp-Arida, Ruth Sargenta, Carol Hawkins, et al. Clinical spectrum of non-alcoholic fatty liver disease in diabetic and non-diabetic patients. BBA Clinical. 2015;3:141-5.

Ashutosh M. Somalwar, Arshish D. Raut, Study of association of non-alcoholic fatty liver disease (NAFLD) with micro and macrovascular complications of type 2 diabetes mellitus (T2DM). Int J Res Med Sci. 2014;2(2):493-7.

Silverman JF, Pories WJ, et al. Liver pathology in diabetes mellitus and morbid obesity. Clinical, pathological, and biochemical considerations. Pathol Annu. 1989;24 Pt 1:275-302.

Hajieh Bibi Shahbazian, Seyed Jalal Hashemi, Seyed Mahmood Latifi, Gholamreza Lashkarara, Gholamreza Alizadeh Attar. Prevalence of fatty liver disease and its risk factors in type 2 diabetic patients; Iranian J Diabetes and Obesity. 2011;3:2.