Non-alcoholic Fatty Liver Disease is Independently Associated with an Increased Prevalence of Chronic Kidney Disease and Retinopathy in Type 1 Diabetic Patients

Overview

Journal Diabetologia

Specialty Endocrinology

Date 2010 Apr 7

PMID 20369224

Citations 53

Authors

G Targher

L Bertolini

M Chonchol

S Rodella

G Zoppini

G Lippi

L Zenari

E Bonora

Affiliations

Soon will be listed here.

Abstract

Aims/hypothesis: Non-alcoholic fatty liver disease (NAFLD) is associated with an increased prevalence of chronic kidney disease (CKD) and retinopathy in patients with type 2 diabetes. Information on this issue is lacking for type 1 diabetes. We evaluated whether NAFLD is associated with increased prevalence of retinopathy and CKD in type 1 diabetic patients.

Methods: All type 1 diabetic patients (n = 202) who regularly attended our diabetes clinic and did not have any clinical evidence of cirrhosis or other secondary causes of chronic liver disease were studied. Main study measures were detection of NAFLD (by patient history and liver ultrasound), diabetic retinopathy (diagnosed by ophthalmoscopy) and CKD (defined as abnormal albuminuria or estimated GFR of < or =60 ml min(-1) 1.73 m(-2)).

Results: The age- and sex-adjusted prevalence of diabetic retinopathy (53.2 vs 19.8%) and CKD (37.8 vs 9.9%) was markedly higher in patients with NAFLD than in those without (p < 0.0001). In multivariate logistic regression analysis, NAFLD was associated with prevalent retinopathy (adjusted OR 3.31, 95% CI 1.4-7.6, p = 0.005) or CKD (adjusted OR 3.90, 95% CI 1.5-10.1, p = 0.005). These associations were independent of age, sex, diabetes duration, HbA(1c), medication use and presence of the metabolic syndrome.

Conclusions/interpretation: Our findings suggest that ultrasound-diagnosed NAFLD is associated, independently of several confounding factors, with a higher prevalence of CKD and retinopathy in type 1 diabetic individuals.

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References

Mohamed Q, Gillies M, Wong T . Management of diabetic retinopathy: a systematic review. JAMA. 2007; 298(8):902-16. DOI: 10.1001/jama.298.8.902. View

Prati D, Taioli E, Zanella A, Della Torre E, Butelli S, Del Vecchio E . Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med. 2002; 137(1):1-10. DOI: 10.7326/0003-4819-137-1-200207020-00006. View

Girman C, Rhodes T, Mercuri M, Pyorala K, Kjekshus J, Pedersen T . The metabolic syndrome and risk of major coronary events in the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS). Am J Cardiol. 2004; 93(2):136-41. DOI: 10.1016/j.amjcard.2003.09.028. View

Targher G, Chonchol M, Miele L, Zoppini G, Pichiri I, Muggeo M . Nonalcoholic fatty liver disease as a contributor to hypercoagulation and thrombophilia in the metabolic syndrome. Semin Thromb Hemost. 2009; 35(3):277-87. DOI: 10.1055/s-0029-1222606. View

Targher G, Bosworth C, Kendrick J, Smits G, Lippi G, Chonchol M . Relationship of serum bilirubin concentrations to kidney function and albuminuria in the United States adult population. Findings from the National Health and Nutrition Examination Survey 2001-2006. Clin Chem Lab Med. 2009; 47(9):1055-62. DOI: 10.1515/CCLM.2009.244. View

Joseph A, Saverymuttu S, Al-Sam S, Cook M, Maxwell J . Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease. Clin Radiol. 1991; 43(1):26-31. DOI: 10.1016/s0009-9260(05)80350-2. View

Lee D, Jacobs Jr D, Gross M, Steffes M . Serum gamma-glutamyltransferase was differently associated with microalbuminuria by status of hypertension or diabetes: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Clin Chem. 2005; 51(7):1185-91. DOI: 10.1373/clinchem.2004.045872. View

Stevens L, Coresh J, Greene T, Levey A . Assessing kidney function--measured and estimated glomerular filtration rate. N Engl J Med. 2006; 354(23):2473-83. DOI: 10.1056/NEJMra054415. View

Targher G, Bertolini L, Padovani R, Rodella S, Tessari R, Zenari L . Prevalence of nonalcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients. Diabetes Care. 2007; 30(5):1212-8. DOI: 10.2337/dc06-2247. View

10.

Ryu S, Chang Y, Kim D, Kim W, Suh B . gamma-Glutamyltransferase as a predictor of chronic kidney disease in nonhypertensive and nondiabetic Korean men. Clin Chem. 2006; 53(1):71-7. DOI: 10.1373/clinchem.2006.078980. View

11.

Wieckowska A, Papouchado B, Li Z, Lopez R, Zein N, Feldstein A . Increased hepatic and circulating interleukin-6 levels in human nonalcoholic steatohepatitis. Am J Gastroenterol. 2008; 103(6):1372-9. DOI: 10.1111/j.1572-0241.2007.01774.x. View

12.

Misra V, Khashab M, Chalasani N . Nonalcoholic fatty liver disease and cardiovascular risk. Curr Gastroenterol Rep. 2009; 11(1):50-5. PMC: 2732016. DOI: 10.1007/s11894-009-0008-4. View

13.

Kotronen A, Yki-Jarvinen H . Fatty liver: a novel component of the metabolic syndrome. Arterioscler Thromb Vasc Biol. 2007; 28(1):27-38. DOI: 10.1161/ATVBAHA.107.147538. View

14.

Adams L, Lindor K . Nonalcoholic fatty liver disease. Ann Epidemiol. 2007; 17(11):863-9. DOI: 10.1016/j.annepidem.2007.05.013. View

15.

Wilkinson C, Ferris 3rd F, Klein R, Lee P, Agardh C, Davis M . Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003; 110(9):1677-82. DOI: 10.1016/S0161-6420(03)00475-5. View

16.

Ratziu V, Imbert-Bismut F, Messous D, Poynard T . The elusiveness of "normal" ALT in fatty liver. Hepatology. 2004; 39(4):1172. DOI: 10.1002/hep.20187. View

17.

Pambianco G, Costacou T, Orchard T . The prediction of major outcomes of type 1 diabetes: a 12-year prospective evaluation of three separate definitions of the metabolic syndrome and their components and estimated glucose disposal rate: the Pittsburgh Epidemiology of Diabetes.... Diabetes Care. 2007; 30(5):1248-54. DOI: 10.2337/dc06-2053. View

18.

Targher G, Bertolini L, Poli F, Rodella S, Scala L, Tessari R . Nonalcoholic fatty liver disease and risk of future cardiovascular events among type 2 diabetic patients. Diabetes. 2005; 54(12):3541-6. DOI: 10.2337/diabetes.54.12.3541. View

19.

Targher G, Marra F, Marchesini G . Increased risk of cardiovascular disease in non-alcoholic fatty liver disease: causal effect or epiphenomenon?. Diabetologia. 2008; 51(11):1947-53. DOI: 10.1007/s00125-008-1135-4. View

20.

Mehta S, Thomas E, Bell J, Johnston D, Taylor-Robinson S . Non-invasive means of measuring hepatic fat content. World J Gastroenterol. 2008; 14(22):3476-83. PMC: 2716608. DOI: 10.3748/wjg.14.3476. View