Prognostic impact of liver fibrosis and steatosis by transient elastography for cardiovascular and mortality outcomes in individuals with nonalcoholic fatty liver disease and type 2 diabetes: the Rio de Janeiro Cohort Study

Abstract Background Liver stiffness measurement (LSM, which reflects fibrosis) and controlled attenuation parameter (CAP, which reflects steatosis), two parameters derived from hepatic transient elastography (TE), have scarcely been evaluated as predictors of cardiovascular complications and mortality in individuals with type 2 diabetes and nonalcoholic fatty liver disease (NAFLD). Methods Four hundred type 2 diabetic patients with NAFLD had TE examination (by Fibroscan®) performed at baseline. Multivariate Cox analyses evaluated the associations between TE parameters and the occurrence of cardiovascular events (CVEs) and mortality. TE parameters were assessed as continuous variables and dichotomized at low/high values reflecting advanced liver fibrosis (LSM > 9.6 kPa) and severe steatosis (CAP > 296 or > 330 dB/m). Improvements in risk discrimination were assessed by C-statistic and by the relative Integrated Discrimination Improvement (IDI) index. Results During a median follow-up of 5.5 years, 85 patients died (40 from cardiovascular causes), and 69 had a CVE. As continuous variables, an increasing LSM was a risk marker for total CVEs (hazard ratio [HR]: 1.05; 95% CI: 1.01–1.08) and all-cause mortality (HR: 1.04; 95% CI: 1.01–1.07); whereas an increasing CAP was a protective factor for both outcomes (HR: 0.93; 95% CI: 0.89–0.98; and HR: 0.92; 95% CI: 0.88–0.97; respectively). As dichotomized variables, a high LSM remained a risk marker of adverse outcomes (with HRs ranging from 2.5 to 3.0) and a high CAP was protective (with HRs from 0.3 to 0.5). The subgroup of individuals with low-LSM/high-CAP had the lowest risks while the opposite subgroup with high-LSM/low-CAP had the highest risks. Both LSM and CAP improved risk discrimination, with increases in C-statistics up to 0.037 and IDIs up to 52%. Conclusions Measured by hepatic TE, advanced liver fibrosis is a risk marker and severe steatosis is a protective factor for cardiovascular complications and mortality in individuals with type 2 diabetes and NAFLD.

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High Prevalence of Advanced Liver Fibrosis Assessed by Transient Elastography Among U.S. Adults With Type 2 Diabetes

Diabetes Care ◽

10.2337/dc20-1778 ◽

2020 ◽

pp. dc201778

Author(s):

Stefano Ciardullo ◽

Tommaso Monti ◽

Gianluca Perseghin

Keyword(s):

Type 2 Diabetes ◽

Liver Fibrosis ◽

Transient Elastography ◽

High Prevalence ◽

Advanced Liver Fibrosis

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1463-P: Relationship between Hepatic and Adipose Tissue Insulin Resistance with Liver Fibrosis in Patients with Type 2 Diabetes Mellitus (T2DM) and Nonalcoholic Fatty Liver Disease (NAFLD)

Diabetes ◽

10.2337/db20-1463-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 1463-P

Author(s):

SRILAXMI KALAVALAPALLI ◽

ROMINA LOMONACO ◽

EDDISON GODINEZ ◽

NADA FANOUS ◽

LAZARO J. TEJERA ◽

...

Keyword(s):

Diabetes Mellitus ◽

Insulin Resistance ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Adipose Tissue ◽

Liver Disease ◽

Liver Fibrosis ◽

Fatty Liver Disease ◽

Nonalcoholic Fatty Liver

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Prevalence of clinically relevant liver fibrosis due to nonalcoholic fatty liver disease in Indian individuals with type 2 diabetes

JGH Open ◽

10.1002/jgh3.12606 ◽

2021 ◽

Author(s):

Mohammad Shafi Kuchay ◽

Narendra Singh Choudhary ◽

Sunil Kumar Mishra ◽

Tarannum Bano ◽

Sakshi Gagneja ◽

...

Keyword(s):

Type 2 Diabetes ◽

Liver Disease ◽

Liver Fibrosis ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Fatty Liver Disease ◽

Nonalcoholic Fatty Liver

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Atherogenic dyslipidemia, but not hyperglycemia, is an independent factor associated with liver fibrosis in subjects with type 2 diabetes and NAFLD: A population –based study

Acta Endocrinologica ◽

10.1530/eje-20-1240 ◽

2021 ◽

Author(s):

María Teresa Julián ◽

Guillem Pera ◽

Berta Soldevila ◽

Llorenç Caballería ◽

Josep Julve ◽

...

Keyword(s):

Type 2 Diabetes ◽

Liver Fibrosis ◽

Multivariable Analysis ◽

Liver Stiffness ◽

Population Based ◽

Atherogenic Dyslipidemia ◽

Population Based Study ◽

Factors Associated ◽

Advanced Liver Fibrosis

Objective: To investigate the prevalence and risks factors associated with the presence of significant liver fibrosis in subjects with nonalcoholic fatty liver disease (NAFLD) with and without type 2 diabetes mellitus (T2D). Design and methods: This study was part of a population-based study conducted in the Barcelona metropolitan area among subjects aged 18-75 years old. Secondary causes of steatosis were excluded. Moderate-to-advanced liver fibrosis was defined as a liver stiffness measurement (LSM) ≥ 8.0 kPa assessed by transient elastography. Results: Among 930 subjects with NAFLD, the prevalence of moderate-to-advanced liver fibrosis was higher in subjects with T2D compared those without (30.8% vs. 8.7%). By multivariable analysis, one of the main factors independently associated with increased LSM in subjects with NAFLD was atherogenic dyslipidemia, but only in those with T2D. The percentage of subjects with LSM ≥ 8.0 kPa was higher in subjects with T2D and atherogenic dyslipidemia than in those with T2D without atherogenic dyslipidemia, both for the cut-off point of LSM ≥8.0 kPa (45% vs 24%, p=0.002) and 13 kPa (13% vs 4%, p=0.020). No differences were observed in the prevalence of LSM ≥8.0 kPa regarding glycemic control among NAFLD-diabetic subjects. Conclusions: Factors associated with moderate-to-advanced liver fibrosis in NAFLD are different in subjects with and without T2D. Atherogenic dyslipidemia was associated with the presence of moderate-to-advanced liver fibrosis in T2D with NAFLD but not in non-diabetic subjects. These findings highlight the need for an active search for liver fibrosis in subjects with T2D, NAFLD and atherogenic dyslipidemia.

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Advanced liver fibrosis predicts poor cardiovascular outcomes in patients with type 2 diabetes

Journal of Hepatology ◽

10.1016/s0168-8278(20)30819-9 ◽

2020 ◽

Vol 73 ◽

pp. S155-S156

Author(s):

Ho Soo Chun ◽

Hye Yeon Chon ◽

Jae Seung Lee ◽

Hye Won Lee ◽

Beom Kyung Kim ◽

...

Keyword(s):

Type 2 Diabetes ◽

Liver Fibrosis ◽

Cardiovascular Outcomes ◽

Advanced Liver Fibrosis

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Liver and Nonliver-Related Outcomes at 2 Years Are Not Influenced by the Results of the FIB-4 Test and Liver Elastography in a Real-Life Cohort of Patients with Type 2 Diabetes

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2021/5582813 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Ivica Grgurevic ◽

Nermin Salkic ◽

Sanda Mustapic ◽

Tomislav Bokun ◽

Kristian Podrug ◽

...

Keyword(s):

Type 2 Diabetes ◽

Liver Fibrosis ◽

Fatty Liver ◽

Transient Elastography ◽

Liver Steatosis ◽

Liver Stiffness ◽

Real Life ◽

Adverse Outcomes ◽

Advanced Fibrosis

Aims. To investigate morbidity and mortality in a real-life cohort of patients with type 2 diabetes (T2D) in relation to prevalence and severity of nonalcoholic fatty liver disease (NAFLD). Methods. Patients with T2D were referred for assessment of liver fibrosis by the FIB-4 test and liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE). Liver steatosis was quantified by the controlled attenuation parameter (CAP). These patients were followed until death or censored date. Results. Among 454 patients (52% males, mean age 62.5 years, BMI 30.9 kg/m2), 82.6% was overweight, 77.8% had fatty liver, and 9.9% and 3.1% had LSM and FIB-4 values suggestive of advanced fibrosis, respectively. During the follow-up period of median 2 years, 106 (23%) patients experienced adverse event (11% cardiovascular) and 17 (3.7%) died, whereas no liver-related morbidity or mortality was observed. Independent predictors of adverse outcomes were age and higher platelet count, while FIB-4, LSM, and CAP were not. Conclusion. In a cohort of T2D patients, no liver-related morbidity or mortality occurred during 2 years. Our patients probably have low real prevalence of advanced fibrosis which is likely overestimated by LSM ≥ 9.6 kPa. Liver fibrosis may be safely reassessed in the 2 years interval in noncirrhotic patients with T2D.

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