Original ArticlesImpact of Type 2 Diabetes on Nonalcoholic Steatohepatitis and Advanced Fibrosis in Patients with Nonalcoholic Fatty Liver Disease
Section snippets
INTRODUCTION
The global prevalence of nonalcoholic fatty liver disease (NAFLD) is rapidly increasing. Indeed, it has been established that the global prevalence of NAFLD reaches 25%, which makes it one of the most common causes of chronic liver disease in many parts of the world (1,2).
Studies show that type 2 diabetes mellitus (T2DM) is a risk factor for NAFLD, including nonalcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and even hepatic carcinoma, and is related to a worse prognosis for NAFLD (3,4).
Patients
The participants were from the fatty liver clinic of Zhongshan Hospital, Fudan University. Patients diagnosed with fatty liver by ultrasonography who had indications of liver biopsy, such as diabetes, obesity, or an elevated level of liver enzymes, were suggested to undergo liver biopsy according to the EASL–EASD–EASO clinical practice guidelines (13); only some of the patients agreed to the procedure. Among all patients, 221 (117 men and 104 women, 11 with simple steatosis and 210 with NASH,
Clinical Characteristics of Subjects
A total of 221 patients with biopsy-proven NAFLD (mean age 44 ± 15 years, female/male 104/117) were enrolled in this study. The BMI and LFC (1H-MRS) of this population were 29.0 ± 4.6 kg/m2 and 42.4% (25th to 75th percentiles, 22.3 to 54.9%), respectively (Table 1). The percentage of T2DM in this population was 69.7%.
To investigate the percentage of NASH and advanced fibrosis in patients with T2DM, we next divided subjects into two groups, non-T2DM and T2DM, based on glycometabolism status. The
DISCUSSION
In this study, SAF score and NAS were used to evaluate the severity of liver histology in NAFLD patients with or without T2DM. The major findings are as follows: (1) the total percentages of NASH and advanced fibrosis in this cohort were 95.0% and 50.2%, respectively; (2) the percentage of advanced fibrosis in the T2DM group was much higher than that in the non-T2DM group (56.5% versus 35.8%); (3) NAS and SAF score in patients with T2DM were higher than in patients without T2DM; (4) glycemic
CONCLUSION
In conclusion, the percentages of NASH and advanced fibrosis in this population were 95.0% and 50.2%, respectively. The percentages of NASH and advanced fibrosis in the NAFLD patients with T2DM were 96.1% and 56.5%, respectively. Based on two methods, SAF score and NAS, we found that the severity of liver disease based on histology in the patients with T2DM was much more serious than that in individuals without T2DM. Moreover, glycemic control and insulin resistance indicators, such as FPG,
REFERENCES (33)
- et al.
The natural history of nonalcoholic fatty liver disease: a population-based cohort study
Gastroenterology
(2005) - et al.
Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study
Gastroenterology
(2011) Histopathology of non-alcoholic fatty liver disease
Clin Liver Dis
(2009)- et al.
Nonalcoholic fatty liver disease: the new complication of type 2 diabetes mellitus
Endocrinol Metab Clin North Am
(2016) - et al.
Obesity and nonalcoholic fatty liver disease: from pathophysiology to therapeutics
Metabolism
(2019) - et al.
Ultrasonographic fatty liver indicator detects mild steatosis and correlates with metabolic/histological parameters in various liver diseases
Metabolism
(2017) - et al.
Nonalcoholic fatty liver disease in adolescents and young adults: the next frontier in the epidemic
Hepatology
(2017) - et al.
Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes
Hepatology
(2016) - et al.
Nonalcoholic fatty liver disease and diabetes mellitus: pathogenesis and treatment
Nat Rev Endocrinol
(2011) - et al.
Prevalence of nonalcoholic fatty liver disease in the united states: the Third National Health and Nutrition Examination Survey, 1988–1994
Am J Epidemiol
(2013)
Management of nonalcoholic fatty liver disease in patients with type 2 diabetes: a call to action
Diabetes Care
Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: a meta-analysis
Medicine (Baltimore)
Epidemiological modifiers of non-alcoholic fatty liver disease: focus on high-risk groups
Dig Liver Dis
Histopathological stages of nonalcoholic fatty liver disease in type 2 diabetes: prevalences and correlated factors
Liver Int
A prospective evaluation of the role of transient elastography for the detection of hepatic fibrosis in type 2 diabetes without overt liver disease
Scand J Gastroenterol
Diabetes, plasma glucose, and incidence of fatty liver, cirrhosis, and liver cancer: a prospective study of 0.5 million people
Hepatology
Cited by (33)
Body weight loss and glycemic control on the outcomes of patients with NAFLD. The role of new antidiabetic agents
2023, Annals of HepatologyCitation Excerpt :Based on this, it was assumed that, in diabetic patients with NAFLD, optimal glycemic control could have a beneficial effect on histological parameters (particularly fibrosis) as compared to those with poor glycemic control. This issue was demonstrated until recently in several studies [50–55] (Table 1). In a study with 713 NAFLD patients, 49% with DM, 51.3% with advanced fibrosis/cirrhosis, and 69.6% with NASH, a higher mean HbA1c was associated with higher grade of steatosis and ballooned hepatocytes, but not with lobular inflammation.
Improved glycaemic control in patients with type 2 diabetes has a beneficial impact on NAFLD, independent of change in BMI or glucose lowering agent
2023, Nutrition, Metabolism and Cardiovascular DiseasesPostprandial glucose is correlated with an increasing risk of liver fibrosis in Chinese patients with nonalcoholic fatty liver disease: Increased risk of liver fibrosis correlated with PPG
2022, Diabetes and MetabolismCitation Excerpt :To the best of our knowledge, this is the first study to evaluate the association between PPG and the risk of liver fibrosis in NAFLD patients with and without T2DM. It has been widely acknowledged that T2DM is an independent risk factor for liver fibrosis [9–11]. Some cross-sectional studies showed that T2DM patients had a higher prevalence of advanced fibrosis diagnosed by liver biopsy compared with that of the general population [19–21].
The roles of type 2 diabetes and obesity in disease activity and progression of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis
2024, Current Medical Research and Opinion
DISCLOSURE
The authors have no multiplicity of interest to disclose.
- *
These authors contributed equally