I Mikolasevic1, V Domislovic2, T Turk Wensveen3, B Delija4, M Klapan4, T Juric4, A Lukic4, A Mijic4, N Skenderevic5, P Puz6, A Ostojic5, Z Krznaric7, D Radic-Kristo8, T Filipec Kanizaj9, D Stimac10. 1. Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia; Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia; School of Medicine, Rijeka, Croatia. Electronic address: ivana.mikolasevic@gmail.com. 2. Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia. 3. School of Medicine, Rijeka, Croatia; Department of Endocrinology, University Hospital Center Rijeka, Rijeka, Croatia. 4. School of Medicine, Rijeka, Croatia. 5. Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia. 6. Internal Medicine, General Hospital Koprivnica, Koprivnica, Croatia. 7. Department for Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, Zagreb, Croatia. 8. Department of Hematology, University Hospital Merkur, Zagreb, Croatia; School of Medicine, Osijek, Croatia. 9. Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia; School of Medicine, Zagreb, Croatia. 10. Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia; School of Medicine, Rijeka, Croatia.
Abstract
AIM: To investigate the prevalence and severity of nonalcoholic fatty liver disease (NAFLD) in patients with diabetes mellitus type 2 (T2DM), based on increased controlled attenuation parameter (CAP) and liver stiffness measurements obtained by transient elastography. In addition, we aimed to identify parameters that correlate with increased elastographic parameters of steatosis and fibrosis to provide a better indication when a patient with T2DM should be screened for NAFLD. METHODS: We conducted prospective, cross-sectional study of 679 consecutive adult patients with diagnosed T2DM mean age 65.2±11.6. NAFLD was defined by transient elastography. In 105 patients a percutaneous liver biopsy (LB) was done. RESULTS: The prevalence of NAFLD based on transient elastography was 83.6%. Independent factors associated with increased CAP were higher body mass index, longer T2DM duration, higher serum triglyceride, lower levels of vitamin D, higher C-reactive protein, and higher HOMA-IR. The prevalence of moderate liver fibrosis was 26.9% and advanced liver fibrosis 12.6%. Independent factors associated with moderated fibrosis based on elastography were higher body mass index and higher levels of alanine aminotransferase (ALT), while independent factors associated with advanced fibrosis were female gender, higher body mass index, higher levels of ALT, gama-glutamil transferase and C-reactive protein. Sixty-four (60.9%) of 105 patients with LB had NAFLD activity score ≥5. Regarding the presence and stages of fibrosis based on LB, moderate fibrosis was found in 29.5% of patients, while 29.5% had advanced fibrosis and 6.7% cirrhosis. CONCLUSION: This study supports more aggressive screening for NAFLD and fibrosis in patients with T2DM.
AIM: To investigate the prevalence and severity of nonalcoholic fatty liver disease (NAFLD) in patients with diabetes mellitus type 2 (T2DM), based on increased controlled attenuation parameter (CAP) and liver stiffness measurements obtained by transient elastography. In addition, we aimed to identify parameters that correlate with increased elastographic parameters of steatosis and fibrosis to provide a better indication when a patient with T2DM should be screened for NAFLD. METHODS: We conducted prospective, cross-sectional study of 679 consecutive adult patients with diagnosed T2DM mean age 65.2±11.6. NAFLD was defined by transient elastography. In 105 patients a percutaneous liver biopsy (LB) was done. RESULTS: The prevalence of NAFLD based on transient elastography was 83.6%. Independent factors associated with increased CAP were higher body mass index, longer T2DM duration, higher serum triglyceride, lower levels of vitamin D, higher C-reactive protein, and higher HOMA-IR. The prevalence of moderate liver fibrosis was 26.9% and advanced liver fibrosis 12.6%. Independent factors associated with moderated fibrosis based on elastography were higher body mass index and higher levels of alanine aminotransferase (ALT), while independent factors associated with advanced fibrosis were female gender, higher body mass index, higher levels of ALT, gama-glutamil transferase and C-reactive protein. Sixty-four (60.9%) of 105 patients with LB had NAFLD activity score ≥5. Regarding the presence and stages of fibrosis based on LB, moderate fibrosis was found in 29.5% of patients, while 29.5% had advanced fibrosis and 6.7% cirrhosis. CONCLUSION: This study supports more aggressive screening for NAFLD and fibrosis in patients with T2DM.
Authors: Anne-Marieke van Dijk; Jörn M Schattenberg; Adriaan G Holleboom; Maarten E Tushuizen Journal: United European Gastroenterol J Date: 2021-10-05 Impact factor: 4.623