Risk Factors for Severe Liver Disease in Patients With Type 2 Diabetes

NAFLD (non-alcoholic fatty liver disease) and AF (atrial fibrillation) are two pathological conditions that are highly prevalent in developed countries and share multiple risk factors. The relationship between NAFLD and AF in Type 2 diabetes is currently unknown. We studied a hospital-based sample of 702 patients with Type 2 diabetes discharged from our Division of Endocrinology during 2007–2011. The diagnosis of AF was confirmed in affected participants on the basis of ECGs and medical history by experienced cardiologists. NAFLD was defined by ultrasonographic detection of hepatic steatosis in the absence of other liver diseases. Of the 702 hospitalized patients included in the study, 514 (73.2%) of them had NAFLD and 85 (12.1%) had persistent or permanent AF. NAFLD was associated with an increased risk of prevalent AF {OR (odds ratio), 3.04 [95% CI (confidence interval), 1.54–6.02]; P<0.001}. Adjustments for age, sex, systolic BP (blood pressure), HbA1c, (glycated haemoglobin), estimated GFR (glomerular filtration rate), total cholesterol, electrocardiographic LVH (left ventricular hypertrophy), COPD (chronic obstructive pulmonary disease), and prior history of HF (heart failure), VHD (valvular heart disease) or hyperthyroidism did not attenuate the association between NAFLD and AF [adjusted OR, 5.88 (95% CI, 2.72–12.7); P<0.001]. In conclusion, our results show that ultrasound-diagnosed NAFLD is strongly associated with an increased prevalence of persistent or permanent AF in patients with Type 2 diabetes, independently of several clinical risk factors for AF. The potential impact of NAFLD on AF deserves particular attention, especially with respect to the implications for screening and surveillance strategies in the growing number of patients with NAFLD.

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Frequency of non-alcoholic fatty liver disease in patients with type-2 diabetes mellitus and its associated risk factors

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.5.4211 ◽

2021 ◽

Vol 37 (5) ◽

Author(s):

Shaista Kanwal ◽

Tahir Ghaffar ◽

Azizul Hasan Aamir ◽

Khalid Usman

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Liver Disease ◽

Fatty Liver Disease ◽

Alcoholic Fatty Liver ◽

Associated Risk Factors ◽

Alcoholic Fatty Liver Disease

Objective: Non-Alcoholic Fatty Liver Disease (NAFLD) is emerging as a major public health problem globally especially in patients with Type-2 Diabetes mellitus (T2DM). This study aimed to assess the frequency of NAFLD in patients with T2DM and to study its associated risk factors. Methods: This descriptive study was conducted from April 2020 to October 2020 at the Hayatabad Medical Complex, Peshawar. Adult patients with T2DM were included in the study and underwent abdominal ultrasound for the identification of NAFLD. All the relevant clinical and biochemical characteristics were measured. Results: Out of 384 participants, 236 patients (61.5%) had NAFLD on ultrasound. Patients with NAFLD had higher mean BMI, higher HbA1c, increased waist circumference, raised ALT, higher triglyceride, and low HDL. Logistic regression analysis revealed a statistically significant association with central obesity (OR = 5.448, 95% CI = 1.416-20.959, p = 0.014), higher BMI (OR = 4.435, 95% CI = 2.127-9.246, p < 0.0001), higher HbA1c [> 11%] (OR = 3.602, 95% CI = 1.438-9.019, p = 0.006), and elevated ALT (OR = 3.211, 95% CI = 1.509-6.835, p = 0.002). The highest odds for NAFLD were found for hypertriglyceridemia (OR = 11.624, 95% CI = 5.405-24.998, p < 0.0001) and low HDL (OR = 11.543, 95% CI = 2.590-51.439, p = 0.001), respectively. Conclusions: High frequency of NAFLD along with its associated clinical and laboratory risk factors were revealed. This underpins the significance of screening T2DM patients for NAFLD and assessment for and modification of its associated risk factors in routine clinical practice. doi: https://doi.org/10.12669/pjms.37.5.4211 How to cite this:Kanwal S, Ghaffar T, Aamir AH, Usman K. Frequency of non-alcoholic fatty liver disease in patients with type-2 diabetes mellitus and its associated risk factors. Pak J Med Sci. 2021;37(5):---------. doi: https://doi.org/10.12669/pjms.37.5.4211 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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The Association Between Risk Factors And Ultrasound-Based Grades Of Non-Alcoholic Fatty Liver Disease In Type-2 Diabetes Patients

Jurnal Widya Medika ◽

10.33508/jwm.v5i1.1998 ◽

2019 ◽

Vol 5 (1) ◽

pp. 47-59

Author(s):

FX Himawan Haryanto Jong ◽

Prettysun Ang Mellow

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Body Mass Index ◽

Liver Disease ◽

Total Cholesterol ◽

Fatty Liver Disease ◽

Density Lipoprotein ◽

Alcoholic Fatty Liver ◽

Alcoholic Fatty Liver Disease

Background: Non-alcoholic fatty liver disease (NAFLD) has become more common as the cause of cirrhosis and liver cancer. The liver disease is highly prevalent in people with type-2 diabetes. Indonesia is not spared from the global epidemic of type-2 diabetes. The ultrasound examination is clinically easy-to-use, economical and non-invasive as a tool to detect NAFLD, compared to the gold standard, liver biopsy. To date, there has been no study in Indonesia to link risk factors and ultrasound-based severity grading of NAFLD. Aim: To understand the association between risk factors and ultrasound-based grades of NAFLD in patients with type-2 diabetes. Method: The present study was an observational study with a cross-sectional design (May-October 2018) that involved 82 type-2 diabetes outpatients of the internal medicine clinic in the Gotong Royong Hospital (Surabaya, Indonesia). The risk factors assessed were gender, age, diabetes duration, obesity (anthropometric measurement: body mass index/ BMI, waist circumference and waist-to-hip ratio), glycemic control (hemoglobin A1c/ HbA1c level) and dyslipidemia (lipid profile: total cholesterol, low-density lipoprotein/ LDL, high-density lipoprotein/ HDL and triglyceride). The ultrasound-based grades of NAFLD consisted of grade 0 (no NAFLD), grade 1 (increased liver echogenicity with normal images of intrahepatic vessel lines and diaphragm), grade 2 (blurred image of intrahepatic vessel lines) and grade 3 (blurred images of intrahepatic vessel lines and diaphragm). Statistical p-value was significant at ≤ 0.05. Results: Seventy-eight subjects (95,1%) had NAFLD. The ultrasound-based NAFLD grades were significantly different across age groups (Kruskal-Wallis) but the Spearman’s rank correlation test result was not significant. Body mass index and total cholesterol were positively correlated (r = 0.390 and 0.237, respectively) with the NAFLD grades. Conclusion: Higher BMI and total cholesterol are associated with increased ultrasound-based NAFLD grades.

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