Published online Feb 14, 2021. doi: 10.3748/wjg.v27.i6.523
Peer-review started: November 7, 2020
First decision: December 3, 2020
Revised: December 12, 2020
Accepted: December 27, 2020
Article in press: December 27, 2020
Published online: February 14, 2021
Processing time: 90 Days and 10.2 Hours
Nonalcoholic fatty liver disease (NAFLD) and type-2 diabetes mellitus (T2DM) have an intricate bidirectional relationship. Individuals with T2DM, not only have a higher prevalence of non-alcoholic steatosis, but also carry a higher risk of progression to nonalcoholic steatohepatitis. Experts still differ in their recommendations of screening for NAFLD among patients with T2DM.
To study the prevalence of NAFLD and advanced fibrosis among our patient population with T2DM.
During the study period (November 2018 to January 2020), 59 adult patients with T2DM and 26 non-diabetic control group individuals were recruited prospectively. Patients with known significant liver disease and alcohol use were excluded. Demographic data and lab parameters were recorded. Liver elastography was performed in all patients.
In the study group comprised of patients with T2DM and normal alanine aminotransferase levels (mean 17.8 ± 7 U/L), 81% had hepatic steatosis as diagnosed by elastography. Advanced hepatic fibrosis (stage F3 or F4) was present in 12% of patients with T2DM as compared to none in the control group. Patients with T2DM also had higher number of individuals with grade 3 steatosis [45.8% vs 11.5%, (P < 0.00001) and metabolic syndrome (84.7% vs 11.5%, P < 0.00001)].
A significant number of patients with T2DM, despite having normal transaminase levels, have NAFLD, grade 3 steatosis and advanced hepatic fibrosis as measured by liver elastography.
Core Tip: Individuals with type 2 diabetes mellitus (T2DM) have a higher prevalence of non-alcoholic steatosis and a higher risk of progression to non-alcoholic steatohepatitis and cirrhosis. Experts differ in their screening recommendations for nonalcoholic fatty liver disease among patients with T2DM. We prospectively recruited and performed liver elastography on 59 diabetics and 26 non-diabetic control patients. Patients with known liver disease and alcohol use were excluded. Our study shows advanced fibrosis is prevalent among patients with T2DM as compared to non-diabetics, even with normal liver enzymes. Screening for liver fibrosis in all patients with T2DM should be considered, regardless of liver enzyme levels.