Risk factors for non-alcoholic fatty liver disease-associated hepatic fibrosis in type 2 diabetes patients

  • Asieh Mansour
  • Mohammad Reza Mohajeri-Tehrani
  • Majid Samadi
  • Hadis Gerami
  • Mostafa Qorbani
  • Nick Bellissimo
  • Hossein Poustchi
  • Azita HekmatdoostEmail author
Original Article



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.


Hepatic 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.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2019

Authors and Affiliations

  • Asieh Mansour
    • 1
  • Mohammad Reza Mohajeri-Tehrani
    • 2
  • Majid Samadi
    • 3
  • Hadis Gerami
    • 4
  • Mostafa Qorbani
    • 5
    • 6
  • Nick Bellissimo
    • 7
  • Hossein Poustchi
    • 8
  • Azita Hekmatdoost
    • 1
    Email author
  1. 1.Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research InstituteShahid Beheshti University of Medical SciencesTehranIran
  2. 2.Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
  3. 3.Radiology Department, Shariati HospitalTehran University of Medical SciencesTehranIran
  4. 4.Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences InstituteTehran University of Medical SciencesTehranIran
  5. 5.Non-communicable Diseases Research CenterAlborz University of Medical SciencesKarajIran
  6. 6.Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Endocrinology and Metabolism Research InstituteTehran University of Medical SciencesTehranIran
  7. 7.School of Nutrition, Faculty of Community ServicesRyerson UniversityTorontoCanada
  8. 8.Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research InstituteTehran University of Medical SciencesTehranIran

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