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Progression of Nonalcoholic Fatty Liver Disease-Associated Fibrosis in a Large Cohort of Patients with Type 2 Diabetes

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Abstract

Background

Nonalcoholic fatty liver disease (NAFLD) can progress to advanced fibrosis, especially in patients with type 2 diabetes. Small studies have shown that fibrosis can also regress.

Aim

We aimed to provide large-scale data on progression and regression of fibrosis in diabetics with NAFLD.

Methods

Adult diabetic patients with the diagnosis of NAFLD based on ICD-9 codes were identified. We used scores from noninvasive tests to identify patients with advanced fibrosis, calculated at first assessment and last follow-up visit. Cutoff values for advanced fibrosis were AST: ALT ratio > 1.4, AST to platelet ratio index > 1.5, FIB-4 score > 2.67, and NAFLD fibrosis score > 0.676.

Results

Our cohort included 50,695 diabetics with NAFLD (55.3% female; 71% Caucasian; mean age, 51.2 ± 11.6 y). During median follow-up of 84.4 months, 25.8% transitioned from no advanced fibrosis to advanced fibrosis (progression), 6.4% transitioned from advanced fibrosis to no advanced fibrosis (regression), and the rest remained stable. Factors associated with transition to advanced fibrosis were female sex, older age at first evaluation, African-American race, obesity, chronic kidney disease, or coronary artery disease. Use of insulin increased the risk of progression to advanced fibrosis (odds ratio,1.36; p < .001), whereas use of oral hypoglycemic agents, angiotensin 2 receptor blockers, and fibrates was associated with reduced risk (odds ratios, 0.92, 0.94 and 0.90, respectively; all p < .05).

Conclusions

In a large cohort of patients with type 2 diabetes and NAFLD, more than a quarter progressed to advanced fibrosis. These findings indicate the need for early detection and staging of NAFLD in diabetics.

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Authors and Affiliations

  1. Department of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA

    Nabil Noureddin

  2. Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Mazen Noureddin

  3. Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA

    Amandeep Singh

  4. Fatty Liver Program, VP of Academic Affairs, Arizona Liver Health, 2201 Fairview Street, Suite 9, Phoenix, AZ, USA

    Naim Alkhouri

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  1. Nabil Noureddin
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Contributions

Study conception and design were contributed by N.A; Acquisition of data was contributed by A.S., N.A.; Analysis and interpretation of results were contributed by N.N., M.N., A.S., N.A.; Drafting the manuscript was contributed by N.N., M.N., A.S., N.A.

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Correspondence to Naim Alkhouri.

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Noureddin, N., Noureddin, M., Singh, A. et al. Progression of Nonalcoholic Fatty Liver Disease-Associated Fibrosis in a Large Cohort of Patients with Type 2 Diabetes. Dig Dis Sci 67, 1379–1388 (2022). https://doi.org/10.1007/s10620-021-06955-x

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