A Mantovani1, T Turino1, M G Lando1, K Gjini2, C D Byrne3, C Zusi4, F Ravaioli5, A Colecchia2, C Maffeis6, G Salvagno7, G Lippi7, E Bonora1, G Targher8. 1. Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University Hospital of Verona, Verona, Italy. 2. Gastroenterology Unit, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy. 3. Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK; Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, Southampton General Hospital, Southampton, UK. 4. Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University Hospital of Verona, Verona, Italy; Pediatric Diabetes and Metabolic Disorders Unit, Department of Surgical Sciences, Dentistry, Paediatrics and Gynaecology, University Hospital of Verona, Verona, Italy. 5. Department of Medical and Surgical Sciences (DIMEC), University Hospital St Orsola-Malpighi, Alma Mater Studiorum-University of Bologna, Bologna, Italy. 6. Pediatric Diabetes and Metabolic Disorders Unit, Department of Surgical Sciences, Dentistry, Paediatrics and Gynaecology, University Hospital of Verona, Verona, Italy. 7. Section of Clinical Biochemistry, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy. 8. Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University Hospital of Verona, Verona, Italy. Electronic address: giovanni.targher@univr.it.
Abstract
AIM: Despite the high prevalence and serious clinical implications of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM), NAFLD is usually overlooked during routine diabetes care. This study explored the proportion of NAFLD cases and increased liver fibrosis (LF), and the association between LF and either chronic kidney disease (CKD) or cardiovascular complications in T2DM patients. METHODS: The study included 137 patients with non-insulin-treated T2DM and no known liver disease consecutively attending our diabetes outpatients' service who underwent liver ultrasonography and liver stiffness measurement (LSM) using vibration-controlled transient elastography (FibroScan®). RESULTS: The proportion of patients with hepatic steatosis on ultrasonography was 73.7%, and the proportion with significant LF was 17.5% with an LSM cut-off ≥7kPa or 10.2% with an LSM cut-off ≥8.7kPa. The presence of CKD (estimated GFR <60mL/min/1.73m2 and/or abnormal albuminuria) increased significantly across LSM tertiles (from around 15% in tertile 1 to 45% in tertile 3). Cardiovascular complications (previous ischaemic heart disease, ischaemic stroke, permanent atrial fibrillation) also tended to increase across LSM tertiles (from around 15% to 30%). After adjusting for established risk factors and potential confounders, LSM tertile 3 remained significantly associated with an approximately threefold higher risk of prevalent CKD (adjusted OR: 3.28, 95% CI: 1.22-8.90; P=0.019), but not for cardiovascular complications. CONCLUSION: These results suggest that NAFLD and significant LF (as assessed by FibroScan®) are very commonly seen in T2DM outpatients with no known liver disease attending a secondary-care diabetes service, and that increased LF is associated with a greater proportion of chronic vascular complications, especially CKD.
AIM: Despite the high prevalence and serious clinical implications of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM), NAFLD is usually overlooked during routine diabetes care. This study explored the proportion of NAFLD cases and increased liver fibrosis (LF), and the association between LF and either chronic kidney disease (CKD) or cardiovascular complications in T2DMpatients. METHODS: The study included 137 patients with non-insulin-treated T2DM and no known liver disease consecutively attending our diabetes outpatients' service who underwent liver ultrasonography and liver stiffness measurement (LSM) using vibration-controlled transient elastography (FibroScan®). RESULTS: The proportion of patients with hepatic steatosis on ultrasonography was 73.7%, and the proportion with significant LF was 17.5% with an LSM cut-off ≥7kPa or 10.2% with an LSM cut-off ≥8.7kPa. The presence of CKD (estimated GFR <60mL/min/1.73m2 and/or abnormal albuminuria) increased significantly across LSM tertiles (from around 15% in tertile 1 to 45% in tertile 3). Cardiovascular complications (previous ischaemic heart disease, ischaemic stroke, permanent atrial fibrillation) also tended to increase across LSM tertiles (from around 15% to 30%). After adjusting for established risk factors and potential confounders, LSM tertile 3 remained significantly associated with an approximately threefold higher risk of prevalent CKD (adjusted OR: 3.28, 95% CI: 1.22-8.90; P=0.019), but not for cardiovascular complications. CONCLUSION: These results suggest that NAFLD and significant LF (as assessed by FibroScan®) are very commonly seen in T2DM outpatients with no known liver disease attending a secondary-care diabetes service, and that increased LF is associated with a greater proportion of chronic vascular complications, especially CKD.
Authors: Fasiha Kanwal; Jay H Shubrook; Leon A Adams; Kim Pfotenhauer; Vincent Wai-Sun Wong; Eugene Wright; Manal F Abdelmalek; Stephen A Harrison; Rohit Loomba; Christos S Mantzoros; Elisabetta Bugianesi; Robert H Eckel; Lee M Kaplan; Hashem B El-Serag; Kenneth Cusi Journal: Gastroenterology Date: 2021-09-20 Impact factor: 33.883
Authors: Shelley E Harris; Toryn M Poolman; Anastasia Arvaniti; Roger D Cox; Laura L Gathercole; Jeremy W Tomlinson Journal: Am J Physiol Gastrointest Liver Physiol Date: 2020-08-05 Impact factor: 4.052