DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20175079

Prevalence of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus and its correlation with coronary artery disease (CAD)

Anjana Prabhakar, Ambili N. R., Unnikrishnan Kartha T. D., Renymol B.

Abstract


Background: Non-alcoholic fatty liver disease (NAFLD) is a common association of Type 2 diabetes mellitus and diabetes mellitus is a leading risk factor for coronary artery disease (CAD). This study aims at estimating the prevalence of NAFLD by ultrasonography and to correlate NAFLD with CAD in a group of patients with Type 2 DM.

Methods: Consecutive patients of Type 2 diabetes fulfilling the inclusion criteria were recruited. Clinical and biochemical parameters were recorded. NAFLD was diagnosed by ultrasonography.

Results: The prevalence of NAFLD was 41.2% in the study group (n=114) and was higher in females. Prevalence of NAFLD in the younger age group was significantly higher than that in the older age group. Elevated liver enzymes, elevated HbA1C, duration of diabetes, obesity, acanthosis nigricans and metabolic syndrome were all significantly associated with NAFLD. CAD was significantly higher in the NAFLD subgroup (72.46%) compared to the non-NAFLD subgroup (52.63%) (p=0.001). Using binary logistic regression analysis, it was found that NAFLD is an independent predictor of CAD (p=0.002).

Conclusions: NAFLD is extremely common in people with Type 2 diabetes and is associated with a higher prevalence of CAD.NAFLD is an independent risk factor for development of CAD. Thus, identification of NAFLD in diabetics might help in predicting the risk of CAD and to adopt the necessary preventive strategy.

 


Keywords


Coronary artery disease, Diabetes mellitus, Non-alcoholic fatty liver disease

Full Text:

PDF

References


Ghouri N, Preiss D, Sattar N. Liver enzymes, non-alcoholic fatty liver disease, and incident cardiovascular disease: a narrative review and clinical perspective of prospective data. Hepatol. 2010;52(3):1156-61.

Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Non-alcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94(9):2467-74.

Fabbrini E, Sullivan S, Klein S. Obesity and nonalcoholic fatty liver disease: biochemical, metabolic, and clinical implications. Hepatol. 2010;51(2):679-89.

Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology. United States; 2006;43(2 Suppl 1):S99-112.

Lazo M, Clark JM. The epidemiology of nonalcoholic fatty liver disease: a global perspective. Semin Liver Dis. 2008;28(4):339-50.

Medina J, Fernández-Salazar LI, García-Buey L, Moreno-Otero R. Approach to the pathogenesis and treatment of nonalcoholic steatohepatitis. Diabetes care. 2004;27(8):2057-66.

Targher G, Bertolini L, Padovani R, Rodella S, Tessari R, Zenari L, et al. Prevalence of Nonalcoholic Fatty Liver Disease and Its Association with Cardiovascular Disease Among Type 2. Diabetes Care. 2007;30(5):1212-8.

Fracanzani AL, Valenti L, Bugianesi E, Andreoletti M, Colli A, Vanni E, et al. Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes. Hepatol. 2008;48(3):792-8.

Kotronen A, Juurinen L, Hakkarainen A, Westerbacka J, Corner A, Bergholm R, et al. Liver fat is increased in type 2 diabetic patients and underestimated by serum alanine aminotransferase compared with equally obese nondiabetic subjects. Diabetes Care. 2008;31(1):165-9.

Duseja A. Nonalcoholic fatty liver disease in India -a lot done, yet more required! Indian J Gastroenterol. 2010;29(6):217-25.

Gupte P, Amarapurkar D, Agal S, Baijal R, Kulshrestha P, Pramanik S, et al. Non-alcoholic steatohepatitis in type 2 diabetes mellitus. J Gastroenterol Hepatol. 2004;19(8):854-8.

Banerjee S, Ghosh US, Dutta S. Clinicopathological profile of hepatic involvement in type-2 diabetes mellitus and its significance. J Assoc Physicians India. 2008;56:593-9.

Prashanth M, Ganesh HK, Vima MV, John M, Bandgar T, Joshi SR, et al. Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus. J Assoc Physicians India. 2009;57(3):205-10.

Kalra S, Vithalani M, Gulati G, Kulkarni C, Kadam Y, Pallivathukkal J, et al. Study of Prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) in Type 2 Diabetes Patients in India (SPRINT). J Assoc physicians. 2013;61:448-53.

Amarapurkar D, Kamani P, Patel N, Gupte P, Kumar P, Agal S, et al. Artemisa Prevalence of non-alcoholic fatty liver disease: Ann Hepatol. 2007;6(3):161-3.

Uchil D, Pipalia D, Chawla M, Patel R, Maniar S, Narayani, et al. Non-alcoholic fatty liver disease (NAFLD)-the hepatic component of metabolic syndrome. J Assoc Physicians India. 2009;57:201-4.

Williamson RM, Price JF, Glancy S, Perry E, Nee LD, Hayes PC, et al. 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. Diabetes Care. 2011;34(5):1139-44.

Agarwal A K, Jain V, Singla S, Baruah BP, Arya V, Yadav R, et al. Prevalence of non-alcoholic fatty liver disease and its correlation with coronary risk factors in patients with type 2 diabetes. J Assoc Physicians India. 2011;59:351-4

Pratt DS, Kaplan MM. Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med. 2000;342(17):1266-71.

Nath DC and AB. A bayesian approach for autoregressive models in longitudinal data analysis: An application to type 2 diabetes drug comparison. Asian J Appl Sci. 2011;9:640-8.

Dunn W, Xu R, Wingard DL, Rogers C, Angulo P, Younossi ZM, Schwimmer JB. Suspected nonalcoholic fatty liver disease and mortality risk in a population-based cohort study. Ame J Gastroenterol. 2008;103(9):2263-71.

Niriella MA, Dassanayake AS, Kalubovila KV, de Silva AP, Wickramasinghe AR, Kato N, Makaya M, de Silva HJ. 1013 is acanthosis nigricans a useful clinical screening test for non-alcoholic fatty liver disease (NAFLD) in resource poor settings?. J Hepatol. 2009;50:S367.

Liu H, Lu H-Y. Nonalcoholic fatty liver disease and cardiovascular disease. World J Gastroenterol. 2014;20(26):8407-15.

Colak Y, Senates E, Yesil A, Yilmaz Y, Ozturk O, Doganay L, et al. Assessment of endothelial function in patients with nonalcoholic fatty liver disease. Endocrine. 2013;43(1):100-7.