Frequency of Non-Alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus and Its Relationship with Glycemic Status (original) (raw)
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The Journal of the Association of Physicians of India
Background: Type 2 diabetes mellitus (T2DM) patients potentially are at risk of developing non-alcoholic fatty liver disease (NAFLD), Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in developing and developed countries, Global prevalence of NAFLD is 25.24% with highest prevalence in the Middle East and South America and lowest in Africa. Aim of Study: This study aimed to determine the prevalence of NAFLD among T2DM patients, diagnosed by ultrasonography of liver, to study the age, sex in NAFLD and to compare liver enzymes and lipid profile between individuals with NAFLD and without NAFLD. Patients and Methods: A prospective study was conducted of 100 type 2 diabetic Patients visited a private clinic in Aden republic of Yemen, in the period from October 2017 to June 2018. Results: Total of (100 patients) type 2 diabetes mellitus ambulatory patients were selected for the study. 62 patients (62%) had NAFLD and 38 patients (38%) had normal liver on ultrasonography, the prevalence of NAFLD in the present study was 62%, Majority of the study population observed with type 2 diabetes mellitus and NAFLD were females (n=40, 65%), and 22 were males (35%), the age range of diabetic patients with NAFLD was 40-65 years, mean age 53.16 SD ±7.64, Subjects with diabetes mellitus and NAFLD had significant elevation in Alanine transaminase (ALT), cholesterol, LDL, and triglyceride than diabetic subjects without NAFLD. Conclusions: Early detection and optimum control of diabetes mellitus is important to minimize the effect of diabetes on liver. Hence, assay of serum levels of hepatic enzymes, and abdominal ultrasound to detect NAFLD should be done in all patients with T2DM as preliminary diagnostic tests.
https://www.ijhsr.org/IJHSR\_Vol.7\_Issue.3\_March2017/IJHSR\_Abstract.08.html, 2017
Introduction: Non-alcoholic fatty liver disease (NAFLD) and Non-alcoholic steatohepatitis (NASH) are the most common causes of liver disease in western countries. Prevalence of NAFLD is increasing even in developing countries mainly due to the increasing numbers of people with obesity or with metabolic syndrome and type 2 Diabetes Mellitus. Methods: A total of 50 type 2 Diabetes Mellitus (DM) patients were evaluated for detailed history, demographic profile, anthropometric measurements, microvascular complications of type 2 DM, routine blood investigations, and tests for current glycemic status (FBS, PP2BS, HbA1C). Patients underwent ultrasonography to detect NAFLD. Serum transaminses (ALT and AST) levels were measured in all patients and ratio of AST/ALT was calculated to see sensitivity and specificity of same in comparision to ultrasonography. Result: NAFLD was found in 32 (64%) patients out of 50 patients of type 2 DM by ultrasonography. Obesity and dyslipidemia, two important components of metabolic syndrome were found to have statistically significant association with occurrence of NAFLD in type 2 DM patients (p value: <0.01). Most of the patients (87.5%) in NAFLD type 2 DM group were having diabetes for more than 5 years so it seems likely that long duration of diabetes is at higher risk to develop NAFLD. There was highly statistically significant inverse relation between metformin therapy and development of NAFLD, (p value:< 0.001). It was noted that uncontrolled HbA1C level has association with increase prevalence of NAFLD (93.75%). type 2 DM patients with microvascular complications are at increased risk of developing NAFLD (p <0.005). Increased ALT levels (Sensitivity 59.38%, and Specificity 94.44%) and AST/ALT ratio less than one (Sensitivity 96.87% and Specificity 77.78%) were observed more frequently in NAFLD patients as compared to AST (Sensitivity 0 and Specificity 100%), so increased ALT and AST/ALT ratio can be used as biochemical marker to detect chronic liver disease such as NAFLD. Conclusion: High prevalence of NAFLD is seen in Indian type 2 DM population. In our study we demonstrated the association between elements of metabolic syndrome, duration of diabetes, increase HbA1C level and microvascular complications of diabetes mellitus with occurrence of NAFLD. Metformin therapy may have protective role in development of NAFLD especially in type 2 DM. Our study also highlighted importance of evaluation of aminotransferases level in type 2 DM, which can be used as marker for chronic liver disease, like NAFLD in type 2 DM.
British Journal of Medicine and Medical Research, 2015
Backgrounds: Non-alcoholic fatty liver disease (NAFLD) has become one of the major health problems world widely, especially among communities with sedentary lifestyle. The main objectives of this study were to know the prevalence of NAFLD among Saudi patients with T2DM in Jazan region and to determine the most important associated factors. Materials and Methods: A cross sectional study targeted 230 type 2 diabetic patients, who attended Diabetic Center at Jazan General Hospital. All participants were screened for NAFLD Elmakki et al.; BJMMR, 5(7): 872-879, 2015; Article no.BJMMR.2015.094 873 using abdominal ultrasonography in addition to clinical and laboratory workup. Descriptive statistics, Chi square/Fisher exact test and logistic regression were utilized for data analysis. Results: The prevalence of fatty liver in the present study was 47.8% (95% CI 41.1-54.6), with no significant difference between males 49.1% (95% CI 40.0-58.3) and females 46.3% (95% CI 36.6-56.3). The prevalence of NAFLD was found to be 52.9% among patients who their ages range between 40-59 years. Factors associated with NAFLD were found to be age, uric acid, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (p-value<0.05 for all). Conclusion: NAFLD is tremendously common among people with type 2 diabetes in Jazan region and the major associated factors were age, obesity, uric acid and elevated liver enzymes. There was no positive correlation between the presence of fatty liver and duration of DM or the degree of glycemic control.
Prevalence of nonalcoholic fatty liver disease in type 2 diabetes mellitus
Background and objectives: Microvascular and macrovascular complications of Type 2 DM are well studied, but association of T2DM with Non alcoholic fatty liver disease (NAFLD) has been recognized recently. The prevalence of NAFLD amongst T2DM is higher compared to non diabetics. There is evidence that T2DM patients with NAFLD are at higher risk of developing cirrhosis compared to non diabetics. Recent data suggest that the prevalence of NAFLD may also be linked to increased coronary artery disease risk, independent of risk conferred by the elements of metabolic syndrome. Indentifying people with NAFLD would also highlight a subgroup of diabetic patients who would be targeted to decrease their risk of future CAD events.. A total of 122 patients who were known case of Type 2 diabetes mellitus and who satisfied inclusion criteria were included in the study. Results: Out of 122 patients included in study 58(47.5%) had NAFLD, the most common sonographic grade of NAFLD was mild fatty liver (62%), followed by moderate (36%), then severe fatty liver (2%). The mean SGOT, SGPT and ALP levels were 31±14.4 IU/L, 25±14.2 IU/L and 104±47.6 respectively. An elevated level of ALP was found to be significantly higher in patients with NAFLD compared patients without NAFLD. 58.6% patients with NAFLD had BMI above normal compared to 36.2% of patients without NAFLD who had elevated BMI which is statistically significant p=0.0001 Conclusion: Prevalence of NAFLD was 47.5% in T2DM patients was significantly associated with overweight, obesity, raised levels of TG, VLDL, ALP. Microvascular complications of T2DM were found to be significantly higher in patients with NAFLD. Macrovascular complication of T2DM Coronary artery disease was found to be significantly higher in patients with NAFLD.
A study of prevalence of non-alcoholic fatty liver disease in type 2 Diabetes Mellitus
Innovative Publication, 2016
Nonalcoholic fatty liver disease (NAFLD) is one of the common causes of chronic liver disease worldwide and is an emerging important cause of liver disease in India. In the general Indian population, the prevalence of NAFLD is approximately 9-30% but much higher estimates are reported in obese and patients with type 2 diabetes mellitus. Total of 185 diabetic and 105 non-diabetic patients were randomly selected from diabetic and medicine OPD. After taking informed consent, all patients undergone history, examination and routine laboratory investigations, LFT, lipid profile, HbA1c, serum ferritin, C-reactive protein and USG. The results of cases and control were compared with unpaired t-test and p value <.05 was considered significant. The study group (n=185) was divided into a NAFLD group (n=102) and a non-NAFLD group (n=83) and non-diabetic control (n=105). The prevalence of NAFLD in DM was 55.68% and in non-diabetic was 20%. The NAFLD was significantly associated with high BMI, waist circumference and waist hip ratio, higher HbA1c, higher triglyceride levels, hypercholesterolemia, low HDL levels. Serum CRP level (p<0.00001) and serum ferritin level (p<0.0001) were significantly high in NAFLD patients with DM-2. This study showed that patients with central obesity, Poor Glycemic control and dyslipidemia are at increased risk of developing NAFLD. Serum ferritin and Serum CRP could be good noninvasive marker for screening of NAFLD in asymptomatic patients.
Diabetes Epidemiology and Management
Objective: This study aims to investigate the prevalence of nonalcoholic fatty liver disease (NAFLD), to determine the metabolic risk factors of this disease, and to predict nonalcoholic steatohepatitis (NASH) with liver fibrosis in women of different ages and body mass index (BMI). Methods: In 2010-2011, a cross-sectional survey was conducted among 9,360 women at the health checkup center of Zhongnan Hospital (Wuhan, China). The probability of NASH with liver fibrosis was predicted using BAAT (BMI, age, alanine aminotransferase, and triglycerides) score. Results: The prevalence of NAFLD increased from 5.3% to 18.8% in women younger than 45 years versus women aged 45 to 55 years and rose to 27.8% in women older than 55 years. In obese women, the prevalence of NAFLD was 48.4%. Women older than 45 years and obese women with NAFLD had more unfavorable metabolic risk factors. Multiple regression analyses showed that increased BMI and low aspartate aminotransferaseYtoYalanine aminotransferase ratio were closely related to NAFLD in women of different ages, whereas increasing BMI, BAAT score, age, high triglycerides, alanine aminotransferase, and low aspartate aminotransferaseYtoYalanine aminotransferase ratio were all closely related to NAFLD in obese women. The prevalence of NASH with a BAAT index of 3 or higher was 13.2% and 14.9% in women older than 55 years and obese women with NAFLD, respectively. Conclusions: Obese and postmenopausal women have a high prevalence of NAFLD and severe metabolic disorders. The prevalence of NASH seems to be considerably higher in obese and postmenopausal women with NAFLD.
Background: Metabolic risk factors associated with non-alcoholic fatty liver disease (NAFLD) include Type 2 diabetes mellitus (T2DM), obesity and dyslipidaemia. Prevention or management of these risk factors with glycaemic control, weight reduction and low serum lipid levels respectively have been reported to reduce the risk of NAFLD or slow its progression. Since ultrasound (USS) is a safe and reliable method of identifying fatty changes in the liver, this study was done to determine the relationship between glycaemic control and ultrasound diagnosed NAFLD in T2DM. Methodology: : Demographic data, anthropometric measurements and laboratory tests including glycated haemoglobin (HbA1c), fasting blood glucose (FBG) and serum lipids of 80 T2DM subjects aged 40-80 years were taken. Their livers were evaluated using B-mode ultrasound, and the data obtained were statistically analysed using SPSS version 20. Results: Fifty-five of all participants (68.8%) were diagnosed with NAFLD sonographic grades 1, 2 and 3 made up of 13 (16.3%), 26 (32.5%) and 16 (20.0%), respectively while 25 (37.2%) had grade 0. The prevalence of NAFLD in T2DM varied significantly with BMI (p ¼ 0.001) and glycaemic control (p ¼ 0.048) while the USS grades of NAFLD varied significantly with age (p ¼ 0.043) and BMI (p ¼ 0.006). The independent strong predictors of NAFLD were overweight (r ¼ 0.409, p ¼ 0.012, OR ¼ 6.626) and obesity (r ¼ 0.411 p ¼ 0.009, OR ¼ 11.508), while poor glycaemic control (r ¼ 0.270, p ¼ 0.015, OR ¼ 3.473) was a moderate independent predictor. Conclusion: The prevalence of NAFLD increases with increasing BMI and HBA1c in T2DM, while its ultrasound grade varies with BMI. Overweight, obesity and poor glycaemic control are independent predictors of NAFLD.
A clinical study of non-alcoholic Fatty Liver disease in Type 2 Diabetes Mellitus
2017
Background: Non-alcoholic fatty liver disease (NAFLD) is no longer considered a benign condition and has been identified as a common cause of chronic liver disease globally. Methods: This study was done on 199 cases of Type 2 Diabetes Mellitus with proper history, thorough clinical examination, including exact height, weight with relevant investigations. Results: The prevalence was 65.8%. Evidence of NAFLD was noted in 59.15% of male and 82.45% of female. Most of the cases were asymptomatic and hepatomegaly was the only commonest physical sign. 83.47% participants with high BMI were found to have NAFLD. The mean of fasting, post-prandial glucose levels and that of HbA 1 C in NAFLD, were significantly higher as compared to that with normal liver. The mean AST, ALT and ALKP levels were significantly higher as compared to the normal liver group. The ratio between AST and ALT was found to be 0.96. The mean of the total cholesterol, triglycerides and LDL were found significantly higher i...
FREQUENCY OF NON-ALCOHOLIC FATTY LIVER DISEASE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Downloaded from www.medrech.com " Frequency of non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus " Abstract Objectives: To determine the frequency of non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus in medical B Unit of Khyber Teaching Hospital, Peshawar. Materials and Methods: This cross-sectional study was conducted in Medical B Unit of Khyber Teaching Hospital, Peshawar, from 1 st April, 2014 to 15 th November, 2014. The study population comprised of male and female patients who were diagnosed as having type 2 diabetes mellitus based on their fasting and random blood sugar levels. All patients had abdominal ultrasounds carried out. Frequency and percentages were calculated for categorical variables like sex and non-alcoholic fatty liver diagnosed on abdominal ultrasound. Non-alcoholic fatty liver was stratified among the age, sex and duration of type-2 diabetes mellitus to see the effect modifiers. All the results were presented as tables and graphs, with the data being entered and analyzed using SPSS version 17. Results: Out of one hundred and forty five patients, 74 (51%) were female and 71 (49%) were male. Mean age of the patients was 47.93±8.57 years. Fifty one (35.17%) of the diabetic patients had fatty liver. Most of the patients (53.7%) fell in age group 40-49. Fatigue was present in 53, generalized weakness in 46, heaviness right upper abdomen in 32 and pain right upper abdomen in 42 of fatty liver patients. Corresponding figures in Non Fatty Liver Patients were 47, 47 and 32 respectively. Itching was noted in 32 patients with fatty liver and 22 with non-fatty liver. Serum triglyceride levels more than 160 mg/dl were seen in 47 (92.15%) patients with fatty liver while serum cholesterol levels more than 200mg/dl were seen in 24 (47.05%) patients. Alanine aminotransferase (ALT) more than 40u/l was noted in 6(4.1%) fatty liver patients while serum albumin and serum bilirubin were within normal range in all fatty liver and non-fatty liver patients. Conclusion: Non-alcoholic fatty liver disease (NAFLD) is more commonly seen in Type-2 diabetic patients. Serum triglyceride and serum cholesterol are significantly raised in NAFLD patients. Diabetic patients having heaviness or pain right upper abdomen with raised serum triglycerides and cholesterol should be more closely observed for NAFLD and liver complications.