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Association of cardiovascular factors in diabetic patients with non-alcoholic fatty liver disease

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Abstract

Purpose

To evaluate the association between severity of hepatic steatosis/fibrosis with clinical, laboratory, and echocardiographic characteristics, including visceral obesity and type 2 diabetes mellitus (T2DM)-related micro- and macrovascular complications in diabetic patients with non-alcoholic fatty liver disease (NAFLD).

Methods

We studied 60 consecutive NAFLD outpatients with T2DM, recording several demographic and clinical characteristics, trunk and visceral fat, cardiac ultrasound, and micro- and macrovascular complications of diabetes mellitus including microalbuminuria, diabetic peripheral neuropathy, peripheral vascular disease, and cardiac autonomic function. Severity of steatosis and fibrosis was evaluated with abdominal ultrasound and liver stiffness measurements, respectively.

Results

Twenty-three (41%) of the patients had grade 1 steatosis and mean liver stiffness was 7.5 ± 3 kPa. After applying Bonferroni correction for multiple comparisons, ferritin concentration was the only factor significantly different between patients with mild (grade 1) compared to those with moderate/severe (grade 2/3) steatosis and showed good discriminative ability for the presence of moderate/severe steatosis (AUC: 0.74, sensitivity 88%, specificity 48%, PPV 74%, and NPV 72%). In addition, waist circumference was the only factor associated with the presence of significant fibrosis (≥ F2) with very good discriminative ability (AUC: 0.77, sensitivity 89%, specificity 45%, PPV 75%, and NPV 70%).

Conclusion

Specific clinical and laboratory characteristics, which may be determined via widely accessible and noninvasive techniques, were associated with severity of diabetics NAFLD, taking into account echocardiographic characteristics, visceral obesity, and T2DM-related systemic complications.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

Abbreviations

T2DM:

Type 2 diabetes mellitus

NAFLD:

Non-alcoholic fatty liver disease

OR:

Odds ratio

C.I.:

Confidence intervals

AUC:

Area under the curve

HCC:

Hepatocellular carcinoma

LT:

Liver transplantation

MetS:

Metabolic syndrome

BMI:

Body mass index

AHT:

Arterial hypertension

CVD:

Cardiovascular disease

NCEP:

National Cholesterol Education Program

ATP III:

Adult Treatment Panel III

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

SAP:

Systolic arterial pressure

WC:

Waist circumference

PLT:

Platelets count

ALT:

Alanine aminotransferase

γ-GT:

γ-Glutamyl transpeptidase

TC:

Total cholesterol

TG:

Triglycerides

HbA1c:

Glycosylated hemoglobin

HDL:

High-density lipoprotein cholesterol

LDL:

Low-density lipoprotein cholesterol

HOMA-IR:

Homeostatic model assessment-insulin resistance

ΒΙΑ:

Bioimpedance analysis

NFS:

NAFLD fibrosis score

LSM:

Liver stiffness measurements

2D-SWE:

Two-dimensional real-time shear wave elastography

IVSD:

Interventricular septal thickness

PWTd:

Posterior wall thickness

EF:

Ejection fraction

LVESD:

Left ventricular (LV) diameter at end-systole

LVEDD:

LV end-diastole

DT:

E-wave deceleration time

IVRT:

Isovolumetric relaxation time

LAD:

Left atrial diameter

DD:

Diastolic dysfunction

UACR:

Urine albumin-to-creatinine ratio

DPN:

Diabetic peripheral neuropathy

NSS:

Neuropathy Symptom Score

NDS:

Neuropathy Disability Score

VPT:

Vibration perception threshold

PVD:

Peripheral vascular disease

cfPWV:

Carotid-femoral pulse wave velocity

CAN:

Cardiac autonomic function

ABI:

Ankle-brachial index

CAN:

Cardiac autonomic function

LF:

Low-frequency

HF:

High-frequency

NNmean:

Mean normal-to-normal R-R interval length

SDNN:

SD of all normal-to-normal R-R intervals

ROC:

Receiver operating characteristic curve

SGLT-2:

Sodium-glucose co-transporter-2

GLP-1:

Glucagon-like peptide-1 (GLP1

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Authors and Affiliations

  1. First Department of Internal Medicine, Medical School of National, Laiko General Hospital, Kapodistrian University of Athens, Agiou Thoma 17, 11527, Athens, Greece

    Evangelos Cholongitas, Panagiota Diamantopoulou & Elpida Mastrogianni

  2. First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Dimitrios Tsilingiris, Anastasios Tentolouris & Nikolaos Tentolouris

  3. Academic Department of Gastroenterology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece

    Dimitrios Karagiannakis & George V. Papatheodoridis

  4. Department of Cardiology, Laiko General Hospital, Athens, Greece

    Ioannis Moyssakis

Authors
  1. Evangelos Cholongitas
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Contributions

All authors equally contributed to this paper concerning conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version. All authors have equally contributed to the study conception and design.

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Correspondence to Evangelos Cholongitas.

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All participants received detailed written and oral information about the study purposes and methodology and provided written consent.

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The authors declare no competing interests.

Research involving human participants

The study adhered to the principles to the ethical guidelines of the 1975 Declaration of Helsinki (as revised in 2000) or comparable ethical standards. Ethical approval was obtained from the Ethics Committee on research on humans of the Laiko University Hospital, Athens, Greece.

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Cholongitas, E., Tsilingiris, D., Diamantopoulou, P. et al. Association of cardiovascular factors in diabetic patients with non-alcoholic fatty liver disease. Hormones 21, 133–145 (2022). https://doi.org/10.1007/s42000-021-00334-x

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