Supervisors info:
Τεντολούρης Νικόλαος, Καθηγητής, Ιατρική Σχολή, Ε.Κ.Π.Α.
Μακρυλάκης Κωνσταντίνος, Αν. Καθηγητής, Ιατρική Σχολή. Ε.Κ.Π.Α.
Κόκκινος Αλέξανδρος, Αν. Καθηγητής, Ιατρική Σχολή, Ε.Κ.Π.Α.
Summary:
Background-Aim: Nonalcoholic fatty liver disease (NAFLD) is characterized by liver steatosis in the absence of alcohol abuse or other causes of chronic liver disease. The global prevalence of NAFLD is currently estimated to be 24%. ΝΑFLD might progress from simple steatosis to steatohepatitis (NASH), fibrosis, cirrhosis and ultimately hepatocellular carcinoma. Diabetes mellitus type 2 (T2DM) is associated with increased NAFLD prevalence and severity, as well as disease progression to hepatic fibrosis and cirrhosis. The estimated prevalence of NAFLD in patients with T2DM is as high as 70-75%. The aim of the current study is to evaluate the prevalence of ΝΑFLD and fibrosis in a population of patients with T2DM. Moreover, we aimed to investigate the association of NAFLD and fibrosis with demographic features, anthropometric characteristics, glycaemic control, lipid profile and microvascular and macrovascular complications of DM.
Methods: In the current cross-sectional study, a total of 22 outpatients with T2DM, were included and investigated. The patients were chosen in a random manner. Patients with a history of alcohol abuse or other cause of chronic liver disease were excluded. Liver fat and liver stiffness/fibrosis was assessed with ultrasonography and shearwave elastography, respectively.
Results: Some degree of NAFLD has been revealed in all patients of the study, while 45,5 % (N=10) of the patients showed advanced fibrosis (F2-F4). Αll patients showed normal aminotransferase levels. Patients with higher degree of NAFLD (>GRADE 1) showed significantly higher values of Hba1c and triglycerides (p=0,035, p=0,035, respectively) and lower values of HDL, SGOT (AST) and SGOT/SGPT (AST/ALT) ratio (p=0,002, p=0,007, p=0,001, respectively), in comparison to patients with low grade NAFLD (GRADE 1). Patients with advanced fibrosis (F2-F4) were significantly older compared to patients with mild fibrosis (F0/F1) (p=0,031). SGOT (AST) values were found to be significantly lower in patients with advanced fibrosis compared to patients with mild fibrosis (p=0,04). HOMA-IR values were significantly higher in patients with advanced fibrosis (6,1±3,8) compared to patients with mild fibrosis (2,6± 1,2) (p=0,013). Diastolic dysfunction of the left ventricle was assessed through echocardiography and it was shown that DT and IVRT measures were significantly higher in patients with advanced fibrosis compared to patients with mild fibrosis (p=0,002, p=0,003 respectively). The prevalence of microvascular and macrovascular complications of DM did not differ between groups with low/high grade ΝAFLD and mild/advanced fibrosis.
Multifactorial logistic regression showed that 1.HDL is independently associated with high grade NAFLD (OR=0,91, 95% CI:0,83-0,99, p=0,025), 2. SGOT/SGPT ratio is independently associated with high grade NAFLD (OR=0,87, 95% CI:0,76-0,99, p=0,047, 3. age is independently correlated with advanced fibrosis (OR=1,19, 95% CI=1,01-1,41, p=0,046), 4.SGOT values are independently associated with advanced fibrosis (OR= 0,67, 95% CI:0,45-0,99, p=0,05).
Conclusions: The prevalence of ΝΑFLD and fibrosis is high among patients with T2DM, even in the absence of abnormal aminotransferase levels. Patients with T2DM and high grade NAFLD show higher values of HbA1c and triglycerides and lower values of HDL, compared to patients with T2DM and low grade NAFLD. Age is significantly associated with advanced fibrosis in patients with T2DM and NAFLD. Patients with T2DM and advanced fibrosis show higher insulin resistance compared to patients with T2DM and mild fibrosis, according to the estimation of HOMA-IR. Moreover, echocardiographic markers of left ventricular diastolic dysfunction, such as DT and IVRT, were higher in patients with T2DM and advanced fibrosis compared to patients with T2DM and mild fibrosis.
