Presence of diabetes mellitus and steatosis is associated... : Hepatology (original) (raw)

Steatohepatitis/Metabolic Liver Disease

Presence of diabetes mellitus and steatosis is associated with liver stiffness in a general population: The Rotterdam study

Koehler, Edith M.1,†; Plompen, Elisabeth P.C.1,†; Schouten, Jeoffrey N.L.2; Hansen, Bettina E.1,3; Darwish Murad, Sarwa*,1; Taimr, Pavel1; Leebeek, Frank W.G.4; Hofman, Albert5; Stricker, Bruno H.5; Castera, Laurent6; Janssen, Harry L.A.1,7

1Department of Gastroenterology and HepatologyErasmus MC University Hospital RotterdamThe Netherlands

2Department of Gastroenterology and HepatologyUniversity Hospital, GhentGhentBelgium

3Department of Public HealthErasmus MC University Hospital RotterdamThe Netherlands

4Department of HematologyErasmus MC University Hospital RotterdamThe Netherlands

5Department of EpidemiologyErasmus MC University Hospital RotterdamThe Netherlands

6Department of HepatologyHôpital Beaujon ClichyFrance

7Toronto Center for Liver Disease, Toronto Western and General HospitalUniversity Health Network Toronto, OntarioCanada

*Address reprint requests to: Sarwa Darwish Murad, M.D., Ph.D., Department of Gastroenterology and Hepatology, Erasmus MC University Hospital, 's‐Gravendijkwal 230, room Ha 204, 3015 CE Rotterdam, The Netherlands. E‐mail:[email protected]; fax: +31 (0) 10 436 5916.

†These authors contributed equally to this work.

Abstract

Given that little is known about the prevalence of, and factors associated with, liver fibrosis in the general population, we aimed to investigate this in a large, well‐characterized cohort by means of transient elastography (TE). This study was part of the Rotterdam Study, a population‐based study among individuals ≥45 years. All participants underwent abdominal ultrasound and TE. Liver stiffness measurement (LSM) ≥8.0 kilopascals (kPa) was used as a cutoff suggesting clinically relevant fibrosis. Of 3,041 participants (age, 66.0 ± 7.6 years) with reliable LSM, 169 (5.6%) participants had LSM ≥8.0 kPa. Age (odds ratio [OR]: 2.40; 95% confidence interval [CI]: 1.72‐3.36; P < 0.001), alanine aminotransferase (ALT; OR, 1.24; 95% CI: 1.12‐1.38; _P_ < 0.001), smoking (OR, 1.77; 95% CI: 1.16‐2.70; _P_ = 0.008), spleen size (OR, 1.23; 95% CI: 1.09‐1.40; _P_ = 0.001), hepatitis B surface antigen, or anti–hepatitis C virus positivity (OR, 5.38; 95% CI: 1.60‐18.0; _P_ = 0.006), and combined presence of diabetes mellitus (DM) and steatosis (OR, 5.20; 95% CI: 3.01‐8.98; _P_ < 0.001 for combined presence) were associated with LSM ≥8.0 kPa in multivariable analyses. The adjusted predicted probability of LSM ≥8.0 kPa increased per age decade, with probabilities ranging from 1.4% (0.9‐3.6) in participants ages 50‐60 years to 9.9% (6.8‐14.5) in participants >80 years. Participants with both DM and steatosis had the highest probabilities of LSM ≥8.0 kPa (overall probability: 17.2% [12.5‐23.4]; this probability did not increase with age [P = 0.8]). Conclusion: In this large population‐based study of older adults, LSM ≥8.0 kPa, suggestive of clinically relevant fibrosis, was present in 5.6% and was strongly associated with steatosis and DM. In the context of an aging population and an increased prevalence of DM and obesity, this study illustrates that liver fibrosis may become a more prominent public health issue in the near future. (Hepatology 2016;63:138–147)