Factors Associated with the Severity of Findings on Hepatic Transient Elastography among Persons with Type 2 Diabetes and Fatty Liver

Joseph Noel Fernando, Rebecca Lim-Alba, Willy Alba

Abstract

Objective. This study aims to determine the relationship between the different factors associated with the severity of Fibroscan with CAP findings among patients with Type 2 diabetes and fatty liver.

Methodology. This is a cross-sectional study. Seven hundred four Fibroscan with Controlled Attenuation Parameter (CAP) results were electronically retrieved from a diagnostic center. Two hundred eighty-five charts of diabetic patients with fatty liver on ultrasound were reviewed. One hundred sixty-four patients with fatty liver on ultrasound and Fibroscan with CAP were included in the study. Several factors were analysed in relation to the severity of Fibroscan with CAP findings in the study group.

Results.Fifty five point five percent (55.5%) (91/164) had significant fibrosis and cirrhosis. Hepatic steatosis prevalence was 96% (158/164). Diabetes >5 years (OR 1.75), HbA1c >7% (OR 2.25) and high SGPT levels (OR 2.39) were associated with liver fibrosis and cirrhosis. BMI >25 kg/m2 (OR 1.45), triglyceride levels >150 mg/dl (OR 1.31) and HbA1c >7% (OR 1.74) were associated with hepatic steatosis.

Conclusion. Factors associated with the severity of hepatic fibrosis, cirrhosis and steatosis included above normal BMI, disease duration of >5 years, poor glycemic control and elevated levels of ALT, and serum triglycerides.

Keywords

type 2 diabetes, NAFLD, transient elastography

Full Text:

Abstract HTML PDF

References

Chalasani Naga, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the study of liver diseases. Hepatology. 2018;67(1):328-57. PMID: 28714183. https://doi.org/10.1002/hep.29367.

Cortés C. Hígado graso no alcohólico: Manifestación hepática del síndrome metabólico. Medicina Familiar. http://medicinafamiliar.uc.cl/html/articulos/542.html.

Teli MR, James OF, Burt AD, Bennett MK, Day CP. The natural history of nonalcoholic fatty liver: A follow‐up study. Hepatology.1995;22(6):1714-9. PMID: 7489979.

Matteoni CA, Younossi ZM, Gramlich T, Boparai M, Liu YC,

McCullough AJ. Nonalcoholic fatty liver disease: A spectrum of clinical and pathological severity. Gastroenterology.

;116(6):1413-9. PMID:10348825. https://doi.org/10.1016/s0016-5085(99)70506-8.

Dam-Larsen S, Franzmann M, Andersen IB, et al. Long term

prognosis of fatty liver: Risk of chronic liver disease and death. Gut. 2004;53(5):750-5. PMID: 15082596. PMCID: PMC1774026. https://doi.org/10.1136/gut.2003.019984.

Ekstedt M, Franzén LE, Mathiesen UL, et al. Long‐term follow‐up of patients with NAFLD and elevated liver enzymes. Hepatology. 2006;44(4):865-73. PMID: 17006923. https://doi.org/10.1002/hep.21327.

Wanless IR, Lentz JS. Fatty liver hepatitis (steatohepatitis) and obesity: an autopsy study with analysis of risk factors. Hepatology. 1990;12(5):1106-10. PMID: 2227807. https://doi.org/10.1002/hep.1840120505.

Williams CD, Stengel J, Asike MI, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middleaged population utilizing ultrasound and liver biopsy: A prospective study. Gastroenterology. 2011;140(1):124-31. PMID: 20858492. https://

doi.org/10.

/j.gastro.2010.09.038.

Wong VW, Wong GL, Choi PC, et al. Disease progression of nonalcoholic

fatty liver disease: A prospective study with paired liver

biopsies at 3 years. Gut. 2010;59(7):969-74. PMID: 20581244. https://doi.org/10.1136/gut.2009.205088.

Fassio E, Alvarez E, Domínguez N, Landeira G, Longo C. Natural history of nonalcoholic steatohepatitis: A longitudinal study of repeat liver biopsies. Hepatology. 2004;40(4):820-6. PMID: 15382171.https://doi.org/10.1002/hep.20410.

Adams LA, Sanderson S, Lindor KD, Angulo P. The histological course of nonalcoholic fatty liver disease: A longitudinal study of 103 patients with sequential liver biopsies. J Hepatol. 2005;42(1):132-8. PMID: 15629518. https://doi.org/10.1016/j.jhep.2004.09.012.

Younossi ZM1, Gramlich T, Matteoni CA, Boparai N, McCullough AJ. Nonalcoholic fatty liver disease in patients with type 2 diabetes. Clin Gastroenterol Hepatol. 2004;2(3):262-5. PMID: 15017611.

Vernon G, Baranova A, Younossi ZM. Systematic review: The epidemiology and natural history of non‐alcoholic fatty liver

disease and non‐alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34(3):274-85. PMID: 21623852. https://doi.org/10.1111/j.1365-2036.2011.04724.x.

Leite NC, Salles GF, Araujo AL, Villela-Nogueira CA, Cardoso CR. Prevalence and associated factors of non‐alcoholic fatty liver disease in patients with type‐2 diabetes mellitus. Liver Int. 2009;29(1):113-9. PMID: 18384521. https://doi.org/10.1111/j.1478-3231.2008.01718.x.

Prashanth M, Ganesh HK, Vima MV, et al. Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus. J Assoc Physicians India. 2009;57:205-10. PMID: 19588648.

European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. Obes Facts. 2016;9(2):65-90. PMID: 27055256. PMCID:PMC5644799. https://doi.org/10.1159/000443344.

Bril F, Cusi K. Management of nonalcoholic fatty liver disease in patients with type 2 diabetes: A call to action. Diabetes Care. 2017;40(3):419-30. PMID: 28223446. https://doi.org/10.2337/dc16-1787.

Wong VW, Vergniol J, Wong GL, et al. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology. 2010;51(2):454-62. PMID: 20101745. https://doi.org/10.1002/hep.23312.

Fraquelli M, Rigamonte C, Casazza G, et al. Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease. Gut. 2007;56(7):968-73. PMID: 17255218. PMCID: PMC1994385. https://doi.org/10.1136/gut.2006.111302.

Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: Natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med. 2011;43(8):617-49. PMID: 21039302. https://doi.org/10.3109/07853890.

518623.

Sasso M, Miette V, Sandrin L, Beaugrand M. The controlled attenuation parameter (CAP): A novel tool for the non-invasive evaluation of steatosis using Fibroscan. Clin Res Hepatol Gastroenterol. 2012;36(1):13-20. PMID: 21920839. https://doi.org/10.1016/j.clinre.2011.08.001.

Prasetya IB, Hasan I, Wisnu W, Rumende CM. Prevalence and profile of fibrosis in diabetic patients with non-alcoholic fatty liver disease and the associated factors. Acta Med Indones. 2017;49(2):91-8. PMID: 28790222.

Lesmana CR, Pakasi LS, Inggriani S, Aidawati M, Lesmana LA. Development of non-alcoholic fatty liver disease scoring system among adult medical check-up patients: A large cross-sectional and prospective validation study. Diabetes Metab Syndr Obes. 2015;8:213-8. PMID: 25960672. PMCID: PMC4410820. https://doi.org/10.2147/DMSO.S80364.

Lim JU, Lee JH, Kim JS, et al. Comparison of World Health Organization and Asia-Pacific body mass index classifications in COPD patients. Int J Chron Obstruct Pulmon Dis. 2017;12: 2465-75. PMID: 28860741.PMCID: PMC5571887. https://doi.org/10.2147/COPD.S141295.

Jimeno C. A summary of the Philippines UNITE for iabetes clinical practice guidelines for the diagnosis and management of diabetes (Part I: Screening and diagnosis of DM). J ASEAN Fed Endocr Soc. 2011;26(1):26-30. https://doi.org/10.15605/jafes.026.01.05.

Grgurevic I, Bokun T, Mustapic S, et al. Prevalence of fatty liver and fibrosis in patients with type 2 diabetes mellitus and previously undetected liver disease as assessed by transient elastography and ultrasound. J Hepatol. 2017;66(1):S661. https://doi.org/10.1016/S0168-8278(17)31789-0.

Roulot D, Roudot-Thoraval F, NKontchou G, et al. Concomitant screening for liver fibrosis and steatosis in French type 2 diabetic patients using Fibroscan. Liver Int. 2017;37(12): 1897-1906. PMID:28556413. https://doi.org/10.1111/liv.13481.

Wang RT, Koretz RL, Yee HF Jr. Is weight reduction an effective therapy for nonalcoholic fatty liver? A systematic review. Am J Med.2003;115(7):554-9. PMID: 14599635. https://doi.org/10.1016/s0002-9343(03)00449-2.

Trovato FM., et al. Neglected features of lifestyle: Their relevance in non-alcoholic fatty liver disease. World J Hepatol. 2016;8(33):1459-65.PMID: 27957244. PMCID: PMC5124717. https://doi.org/10.4254/wjh.v8.i33.1459.