Embedded Files
NON ALCOHOLIC FATTY LIVER DISEASE AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS IN SULAIMANI GOVERNORATE
NON ALCOHOLIC FATTY LIVER DISEASE AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS IN SULAIMANI GOVERNORATE
Fenk B. Maarouf a, Hemn Hadi b and Mohammed O. Mohammed c
a Department of Biochemistry, College of Medicine, University of Sulaimani.
b Directorate of Health of Sulaimani
c Department of Medicine, College of Medicine, University of Sulaimani.
Submitted: 15/10/2016; Accepted: 1/10/2017; Published 31/12/2017
DOI Link: https://doi.org/10.17656/jsmc.10141
ABSTRACT
Background
Nonalcoholic fatty liver disease (NAFLD) is a common hepatic disorder characterized by accumulation of fat in the liver parenchyma of patients who do not drink excessive amount of alcohol. The prevalence of NAFLD is high in conditions associated with insulin resistance, such as obesity, type 2 DM, dyslipidemia and the metabolic syndrome. NAFL is very common in type-2 diabetic patients, with 50-75% demonstrating fat in the liver by ultrasound.
Objectives
To assess the frequency of NAFLD in patients with type 2 DM in Sulaimani and its relation with age, gender, duration and state of glycaemic control compared to non diabetic subjects.
Methods
This is across sectional study, conducted in Sulaimani General Teaching Hospital from December. 2013 to December 2014. A total of 102 patients were enrolled in the study, sixty seven were diabetic and 35 were nondiabetic as control. Patients with chronic viral hepatitis B, C, autoimmune hepatitis, excessive alcohol ingestion, and drugs with adverse effect on liver were excluded. These patients were evaluated by abdominal ultrasonography to determine the presence of fatty liver. They were divided into fatty liver group and non-fatty liver group. They were further evaluated for BMI, waist/hip ratio, blood pressure, lipid profile, liver function test. The data obtained was analyzed using SPSS-21.
Results
61% of diabetic patients had fatty liver on ultrasonography; of those 17% fulfill the criteria of NASH, compared to 48%, 6% in the control group respetively. BMI, serum triglyceride and ALT were significantly higher in group with fatty liver than non fatty liver in both diabetic and control (P-value= 0.001, 0.027, and 0.006 respectively).The frequency of NAFLD increases with age. Diabetes was associated with more severe degree of NAFL and fibrosis score.
Conclusion
NAFLD is more common in type 2 DM than nondiabetic. Obesity, hypertriglyceridemia, and HbA1c are independent predictors of NAFLD.
KEYWORDS
Type 2 DM, NAFLD, NASH, Obesity, Sulaimani.
References
1. Bruce R. Bacon. Nonalcoholic fatty liver disease. In Dan L. Longo, Anthony S. Fauci, Dennis L. Kasper, Stephen L. Hauser, , J. Larry Jameson, Joseph Loscalzo HARRISON’S principle of INTERNAL MEDICINE, 18th edition. New York: McGraw-Hill 2012; 309: 2604-2605. .
2. Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clinic proceedings. 1980; 55(7):434-8.
3. Sheth SG, Gordon FD, Chopra S. Nonalcoholic steatohepatitis. Annals of internal medicine. 1997; 126(2):137-45.
4. Bedogni G, Miglioli L, Masutti F, Tiribelli C, Marchesini G, Bellentani S. Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study. Hepatology. 2005; 42(1):44-52.
5. Clark JM, Brancati FL, Diehl AM. The prevalence and etiology of elevated aminotransferase levels in the United States. The American journal of gastroenterology. 2003; 98(5):960-7.
6. Bellentani S, Saccoccio G, Masutti F, Croce LS, Brandi G, Sasso F, et al. Prevalence of and risk factors for hepatic steatosis in Northern Italy. Annals of internal medicine. 2000; 132(2):112-7.
7. Baldridge AD, Perez-Atayde AR, Graeme-Cook F, Higgins L, Lavine JE. Idiopathic steatohepatitis in childhood: a multicenter retrospective study. The Journal of pediatrics. 1995; 127(5):700-4.
8. Gupte P, Amarapurkar D, Agal S, Baijal R, Kulshrestha P, Pramanik S, et al. Non-alcoholic steatohepatitis in type 2 DM. Journal of gastroenterology and hepatology. 2004; 19(8):854-8.
9. Marchesini G, Brizi M, Morselli-Labate AM, Bianchi G, Bugianesi E, McCullough AJ, et al. Association of nonalcoholic fatty liver disease with insulin résistance. The American journal of medicine. 1999; 107(5):450-5.
10. Dixon JB, Bhathal PS, O'Brien PE. Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology. 2001; 121(1):91-100.
11. Angulo P, Keach JC, Batts KP, Lindor K. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology.1999; 30(6):1356-62.
12. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology. 2012; 142(7):1592-609.
13. Zeng MD, Fan JG, Lu LG, Li YM, Chen CW, Wang BY, et al. Guidelines for the diagnosis and treatment of nonalcoholic fatty liver diseases. Journal of digestive diseases. 2008; 9(2):108-12.
14. Luisito O. Llido, Roberto Mirasol . Comparison of Body Mass Index based nutritional status using WHO criteria Versus “Asian” criteria: PhilSPEN Online Journal of Parenteral and Enteral Nutrition. Jan 2012:1--8.
15. Waist Circumference and Waist–Hip Ratio:Report of a WHO Expert Consultation Geneva, 8–11 December 2008
16. K.G.M.M. Alberti, Robert H. Eckel, Scott M. Grundy, Paul Z. Zimmet, et al. Harmonizing the Metabolic Syndrome. Circulation. 2009; 120:1640-1645
17. Liangpunsakul S, Chalasani N. What should we recommend to our patients with NAFLD regarding alcohol use? The American journal of gastroenterology. 2012; 107(7):976-8.
18. Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007; 45(4):846-54.
19. Shobha Luxmi, Rukhsana Abdul Sattar, Jamal Ara. Association of non-alcoholic fatty liver with type 2 DM. J Liaquat University Med Health Sci. 2008;7(3):188-93.
20. Akbar DH, Kawther AH. Nonalcoholic fatty liver disease in Saudi type 2 diabetic subjects attending a medical outpatient clinic: prevalence and general characteristics. Diabetes care. 2003; 26(12):3351-2.
21. Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004; 40(6):1387-95.
22. Jayarama N, Sudha R. A study of non – alcoholic fatty liver disease in type 2 DM in tertiary care center, Southern India. Journal of Clinical and Diagnostic Research. 2012; 6(2):243-245.
23.Kumar VV, Rohatgi A, Sharma SK. NASH in High Risk Group of Patients WithType-2 DM, Obesity & Dyslipidemia. Journal of Medical Education and Research. 2010; 12(1).
24. Rogha M, Najafi N, Azari A, Kaji M, Pourmoghaddas Z, Rajabi F, et al. Non-alcoholic Steatohepatitis in a Sample of Iranian Adult Population: Age is a Risk Factor. International journal of preventive medicine. 2011; 2(1):24-7.
25. Miyazaki Y, Glass L, Triplitt C, Wajcberg E, Mandarino LJ, DeFronzo RA. Abdominal fat distribution and peripheral and hepatic insulin resistance in type 2 DM. American journal of physiology Endocrinology and metabolism. 2002; 283(6):E1135-43.
26. Krishnan A, Venkataraman J. Prevalence of nonalcoholic fatty liver disease and its biochemical predictors in patients with type-2 diabetic mellitus. E&C Hepatology. 2011; 7(3-4): 7-10.
27. Ma H, Xu C, Xu L, Yu C, Miao M, Li Y. Independent association of HbA1c and nonalcoholic fatty liver disease in an elderly Chinese population. BMC gastroenterology. 2013; 13:3.
28. Luyckx FH, Lefebvre PJ, Scheen AJ. Non-alcoholic steatohepatitis: association with obesity and insulin resistance, and influence of weight loss. Diabetes & metabolism. 2000; 26(2):98-106.
29. Donnelly KL, Smith CI, Schwarzenberg SJ, Jessurun J, Boldt MD, Parks EJ. Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease. The Journal of clinical investigation. 2005; 115(5):1343-51.
30. Shahbazian HB, Hashemi SJ, Latifi SM, Lashkarara G, Attar GA. Prevalence of Fatty Liver Disease and Its Risk Factors in Type 2 Diabetic Patients. Iranian Journal of Diabetes and Obesity. 2011; 3(2).
31. Hu X, Huang Y, Bao Z, Wang Y, Shi D, Liu F, et al. Prevalence and factors associated with nonalcoholic fatty liver disease in Shanghai work-units. BMC gastroenterology. 2012; 12:123.
32. Kalra S, Vithalani M, Gulati G, Kulkarni CM, Kadam Y, Pallivathukkal J, et al. Study of prevalence of nonalcoholic fatty liver disease (NAFLD) in type 2 diabetes patients in India (SPRINT). The Journal of the Association of Physicians of India. 2013; 61(7):448-53.
33. Hossein panah F, Rambod M, Sadeghi L. Predictors of Non-Alcoholic Fatty Liver Disease in Diabetes. International Journal of Endocrinology and Metabolism. 2007; 2: 61-69.
© The Authors, published by University of Sulaimani, College of Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.
Page updated
Report abuse