Risk factors for non-alcoholic fatty liver disease-associated hepatic fibrosis in type 2 diabetes patients
In patients with type 2 diabetes, non-alcoholic fatty liver disease (NAFLD) and liver fibrosis is frequent and presumably associated with increased cardiovascular disease risk and mortality. The objective was to investigate risk factors associated with hepatic fibrosis in patients with type 2 diabetes and NAFLD to provide a basis for the prevention and treatment.
Liver stiffness measurements (LSM) expressed in kilopascals (kPa) and controlled attenuation parameter (CAP) expressed in dB/m were diagnosed by transient elastography. Hepatic steatosis and significant fibrosis were defined as having a CAP score ≥ 260 dB/m and an LSM score ≥ 8 kPa, respectively. Associations between fibrosis categories with anthropometric and metabolic variables were determined; then, variables with statistical significance in the univariate analysis were included in multivariate model.
A total of 108 participant with type 2 diabetes and NAFLD (mean age: 44.69 ± 5.57 years; mean duration of diabetes 4.68 ± 4.24 years) were recruited. In these patients, body mass index, obesity, fat mass, waist circumferences, resting energy expenditure, CAP score, fasting insulin, C-peptide, HbA1C, hs-CRP as well as liver enzymes and systolic blood pressure and diastolic blood pressure were positively associated with fibrosis (all p < 0.05). Using multivariate logistic regression, serum aspartate aminotransferase (OR 1.12; 95% CI 1.06–1.19), waist circumferences (odds ratio [OR] 1.15; 95% CI 1.05–1.25) and C-peptide (OR 3.81; 95% CI 1.5–9.7) remained as independently associated with liver fibrosis.
For participants with type 2 diabetes with coexisting NAFLD, stratification by independent risk factors for fibrosis could have important prognostic value.
KeywordsHepatic fibrosis Type 2 diabetes NAFLD Risk factors Liver enzymes
This study was financially supported by a grant from National Institute for Medical Research Development to AH and AM with Grant No 957225, and the National Nutrition and Food Technology, Research Institute Shahid Beheshti University of Medical Science, Tehran, Iran. We also thank Maryam Sharafkhah for contribution in analysis of data.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures were in accordance with the ethical standards of the institutional research committee (Ethics Committee of the National Institute for Medical Research Development and National Nutrition and Food Technology Research Institute) and with the 1964 Helsinki declaration and its later amendments.
Informed consent was obtained from all individual participants included in the study.
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