TITLE:
A Study of Prevalence of Diabetes and Prediabetes in Patients of Non-Alcoholic Fatty Liver Disease and the Impact of Diabetes on Liver Histology in Coastal Eastern India
AUTHORS:
Shivaram Prasad Singh, Ayaskanta Singh, Girish Kumar Pati, Bijay Misra, Debasis Misra, Sanjib Kumar Kar, Manas Kumar Panigrahi, Chudamani Meher, Omprakash Agrawal, Niranjan Rout, Kaumudi Pattnaik, Pallavi Bhuyan, Amarendra Mohapatra
KEYWORDS:
Fatty Liver, Diabetes, Prediabetes, Liver Histology, Insulin Resistance, Steatohepatitis
JOURNAL NAME:
Journal of Diabetes Mellitus,
Vol.4 No.4,
October
20,
2014
ABSTRACT: Background and Objectives:
Non-alcoholic fatty liver disease (NAFLD) is more common in diabetic patients.
There are limited studies on clinical, biochemical and histological features of
NAFLD patients who are diabetic. The aim of the study was to determine the
prevalence of diabetes and prediabetes in a cohort of NAFLD patients and to
compare anthropometry, biochemical and metabolic parameters and hepatic
histology of diabetic NAFLD patients with non-diabetic NAFLD patients. Methods:
515 consecutive NAFLD patients diagnosed by abdominal ultrasound and 100
healthy controls were subjected to detailed anthropometric measurements and
biochemical assays including blood sugars, LFT, lipid profile and HOMA.
Diabetes and prediabetes were defined according to WHO criteria. Patients were
categorized and compared according to the presence or absence of diabetes.
Liver biopsy was performed in 240 NAFLD patients and the liver histology was
also compared between the two groups. Statistical analysis was performed on
SPSS 16. Results: 124 out of the
515 (24.08%) NAFLD patients were diabetics, 118 out of 515 (22.9%) were pre-diabetics,
while only 3 out of 100 controls had impaired glucose tolerance. Diabetic
patients were older. NAFLD patients with diabetes had significantly higher
waist circumference [98.02 ± 12.01 vs 93.89 ± 8.8, p = 0.000] as compared to
the NAFLD patients without diabetes. Fasting blood sugar [124 ± 46.3 vs 90.8 ±
10.2, p = 0.000], triglyceride level [218.4 ± 17.6 vs 192 ± 9, p = 0.03] and
HOMA-IR [2.6 ± 0.36 vs 1.84 ± 0.2, p Hypertension
[35% vs 11.7%, p = 0.000] was commoner in diabetic NAFLD patients.
Histopathology in the diabetic
patients revealed steatosis alone in 34.2% cases, borderline NASH in 31.4% and
definite NASH in 34.2%. Fatty change alone was noted in 16.5% cases, borderline
NASH in 34.1%, while 49% had definite NASH on liver biopsy of NAFLD patients
without diabetes. Fibrosis was noted in 31.4% in diabetic and 27% in
non-diabetic patients. IR alone had a linear correlation with necroinflammatory
activity. Conclusion: The prevalence of diabetes and prediabetes is six times
more in NAFLD patients than in healthy controls. NAFLD patients with diabetes
have higher metabolic risk factors such as large waistline, hypertension, high
triglyceride levels and increased insulin resistance. Diabetes or pre diabetes
patients per se do not have histologically severe disease, rather insulin
resistance play an important role in increasing the severity of the disease.