Prevalence of and Risk Factors for Hepatic Steatosis and Nonalcoholic Fatty Liver Disease in People with Type 2 Diabetes: the Edinburgh Type 2 Diabetes Study

Overview

Journal Diabetes Care

Specialty Endocrinology

Date 2011 Apr 12

PMID 21478462

Citations 159

Authors

Rachel M Williamson

Jackie F Price

Stephen Glancy

Elisa Perry

Lisa D Nee

Peter C Hayes

Brian M Frier

Liesbeth A F Van Look

Geoffrey I Johnston

Rebecca M Reynolds

Mark W J Strachan

Affiliations

Soon will be listed here.

Abstract

Objective: Type 2 diabetes is an established risk factor for development of hepatic steatosis and nonalcoholic fatty liver disease (NAFLD). We aimed to determine the prevalence and clinical correlates of these conditions in a large cohort of people with type 2 diabetes.

Research Design And Methods: A total of 939 participants, aged 61-76 years, from the Edinburgh Type 2 Diabetes Study (ET2DS)-a large, randomly selected population of people with type 2 diabetes-underwent liver ultrasonography. Ultrasound gradings of steatosis were compared with magnetic resonance spectroscopy in a subgroup. NAFLD was defined as hepatic steatosis in the absence of a secondary cause (screened by questionnaire assessing alcohol and hepatotoxic medication use, plasma hepatitis serology, autoantibodies and ferritin, and record linkage to determine prior diagnoses of liver disease). Binary logistic regression was used to analyze independent associations of characteristics with NAFLD.

Results: Hepatic steatosis was present in 56.9% of participants. After excluding those with a secondary cause for steatosis, the prevalence of NAFLD in the study population was 42.6%. Independent predictors of NAFLD were BMI, lesser duration of diabetes, HbA(1c), triglycerides, and metformin use. These remained unchanged after exclusion of participants with evidence of hepatic fibrosis from the group with no hepatic steatosis.

Conclusions: Prevalences of hepatic steatosis and NAFLD were high in this unselected population of older people with type 2 diabetes, but lower than in studies in which ultrasound gradings were not compared with a gold standard. Associations with features of the metabolic syndrome could be used to target screening for this condition.

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References

Angulo P, Keach J, Batts K, Lindor K . Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology. 1999; 30(6):1356-62. DOI: 10.1002/hep.510300604. View

Sanyal A . AGA technical review on nonalcoholic fatty liver disease. Gastroenterology. 2002; 123(5):1705-25. DOI: 10.1053/gast.2002.36572. View

Angulo P . Nonalcoholic fatty liver disease. N Engl J Med. 2002; 346(16):1221-31. DOI: 10.1056/NEJMra011775. View

Belfort R, Harrison S, Brown K, Darland C, Finch J, Hardies J . A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis. N Engl J Med. 2006; 355(22):2297-307. DOI: 10.1056/NEJMoa060326. View

Fishbein M, Castro F, Cheruku S, Jain S, Webb B, Gleason T . Hepatic MRI for fat quantitation: its relationship to fat morphology, diagnosis, and ultrasound. J Clin Gastroenterol. 2005; 39(7):619-25. DOI: 10.1097/00004836-200508000-00012. View

Trombini P, Piperno A . Ferritin, metabolic syndrome and NAFLD: elective attractions and dangerous liaisons. J Hepatol. 2007; 46(4):549-52. DOI: 10.1016/j.jhep.2007.01.004. View

Fishbein M, Gardner K, Potter C, Schmalbrock P, Smith M . Introduction of fast MR imaging in the assessment of hepatic steatosis. Magn Reson Imaging. 1997; 15(3):287-93. DOI: 10.1016/s0730-725x(96)00224-x. View

Fabbrini E, Conte C, Magkos F . Methods for assessing intrahepatic fat content and steatosis. Curr Opin Clin Nutr Metab Care. 2009; 12(5):474-81. DOI: 10.1097/MCO.0b013e32832eb587. View

Ryan C, Johnson L, Germin B, Marcos A . One hundred consecutive hepatic biopsies in the workup of living donors for right lobe liver transplantation. Liver Transpl. 2002; 8(12):1114-22. DOI: 10.1053/jlts.2002.36740. View

10.

Neuschwander-Tetri B, Caldwell S . Nonalcoholic steatohepatitis: summary of an AASLD Single Topic Conference. Hepatology. 2003; 37(5):1202-19. DOI: 10.1053/jhep.2003.50193. View

11.

Gupte P, Amarapurkar D, Agal S, Baijal R, Kulshrestha P, Pramanik S . Non-alcoholic steatohepatitis in type 2 diabetes mellitus. J Gastroenterol Hepatol. 2004; 19(8):854-8. DOI: 10.1111/j.1440-1746.2004.03312.x. View

12.

Bugianesi E, Gentilcore E, Manini R, Natale S, Vanni E, Villanova N . A randomized controlled trial of metformin versus vitamin E or prescriptive diet in nonalcoholic fatty liver disease. Am J Gastroenterol. 2005; 100(5):1082-90. DOI: 10.1111/j.1572-0241.2005.41583.x. View

13.

Alvarez F, Berg P, Bianchi F, Bianchi L, Burroughs A, Cancado E . International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999; 31(5):929-38. DOI: 10.1016/s0168-8278(99)80297-9. View

14.

Bellentani S, Saccoccio G, Masutti F, Croce L, Brandi G, Sasso F . Prevalence of and risk factors for hepatic steatosis in Northern Italy. Ann Intern Med. 2000; 132(2):112-7. DOI: 10.7326/0003-4819-132-2-200001180-00004. View

15.

Price J, Reynolds R, Mitchell R, Williamson R, Fowkes F, Deary I . The Edinburgh Type 2 Diabetes Study: study protocol. BMC Endocr Disord. 2008; 8:18. PMC: 2621220. DOI: 10.1186/1472-6823-8-18. View

16.

Joy D, Thava V, Scott B . Diagnosis of fatty liver disease: is biopsy necessary?. Eur J Gastroenterol Hepatol. 2003; 15(5):539-43. DOI: 10.1097/01.meg.0000059112.41030.2e. View

17.

El-Serag H, Tran T, Everhart J . Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma. Gastroenterology. 2004; 126(2):460-8. DOI: 10.1053/j.gastro.2003.10.065. View

18.

Williamson R, Perry E, Glancy S, Marshall I, Gray C, Nee L . The use of ultrasound to diagnose hepatic steatosis in type 2 diabetes: intra- and interobserver variability and comparison with magnetic resonance spectroscopy. Clin Radiol. 2011; 66(5):434-9. DOI: 10.1016/j.crad.2010.09.021. View

19.

Crosignani A, Battezzati P, Invernizzi P, Selmi C, Prina E, Podda M . Clinical features and management of primary biliary cirrhosis. World J Gastroenterol. 2008; 14(21):3313-27. PMC: 2716586. DOI: 10.3748/wjg.14.3313. View

20.

Bush K, Kivlahan D, McDonell M, Fihn S, Bradley K . The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998; 158(16):1789-95. DOI: 10.1001/archinte.158.16.1789. View