Factors Associated with Liver Fibrosis in Chinese Patients with Type 2 Diabetes Mellitus and Non-Alcoholic Fatty Liver Disease

Abstract

Purpose Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are frequently co-occurring diseases. Liver fibrosis (LF), with increasing incidence, has a prognostic value for NAFLD mortality. Our study aimed to investigate the relevant factors for FL in T2DM individuals with NAFLD. Patients and Methods A total of 565 T2DM patients with NAFLD from Hebei General Hospital participated in the study. Patients underwent an abdominal ultrasound, a questionnaire and laboratory tests. The fibrosis-4 index (FIB-4) was used to evaluate LF, with FIB ≥1.3 indicating LF and FIB ≥2.67 indicating F3-4 fibrosis. Results Compared with NLF group, LF group had higher levels of systolic blood pressure (SBP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyl transpeptidase (GGT). The glomerular filtration rate (GFR), low-density lipoprotein cholesterol (LDL), glycated hemoglobin (HbA1c), and platelets (PLT) in LF patients were lower than those without LF. Patients with LF were older than those without LF. ALT, AST, and GGT in patients with severe LF were higher than those with mild LF, while platelet was lower. Age, SBP, duration of diabetes, ALT, AST, and GGT were positively correlated with FIB-4, while eGFR, TC, LDL, and HbA1c were negatively correlated with FIB-4. Logistic regression showed that age, SBP, ALT, GGT, LDL, and PLT were independently associated with LF. Conclusion For T2DM patients combined with NAFLD, older age, higher SBP, higher ALT, higher GGT, lower LDL, and lower PLT were relevant factors for LF.

Development and validation of a non-invasive model for predicting significant fibrosis based on patients with nonalcoholic fatty liver disease in the United States

“…Compared with normal patients, patients with diabetes have a higher risk of liver fibrosis. In addition, studies ( 33 , 34 ) have shown that serum AST is increased when liver injury occurs in patients with NAFLD, and it has been preliminarily confirmed that AST level is closely related to the occurrence of liver fibrosis in patients with NAFLD, which is highly similar to our findings. A previous study ( 35 ) showed that patients with advanced fibrosis (F3-F4) were older, more obese, more prone to diabetes and tened to have elevated levels of GGT compared to other groups, thus suggesting that GGT could be a biomarker for liver fibrosis in patients with NAFLD.…”

“…Compared with normal patients, patients with diabetes have a higher risk of liver fibrosis. In addition, studies (33,34) have shown that serum AST is increased when liver injury occurs in patients with NAFLD, and it has been preliminarily A calculator for predicting significant fibrosis probability in patients with nonalcoholic fatty liver disease. confirmed that AST level is closely related to the occurrence of liver fibrosis in patients with NAFLD, which is highly similar to our findings.…”

Prevalence of High and Moderate Risk of Liver Fibrosis Among Patients With Diabetes at a Noncommunicable Diseases (NCD) Clinic in a Primary Healthcare Center in Northern India

“…Specifically, patients who had been living with diabetes for more than five years exhibited elevated odds of developing liver fibrosis. A study conducted by Luo et al also demonstrated a positive correlation between diabetes duration and FIB-4 scores [20]. In line with this, a study conducted in Hong Kong revealed that liver-related events escalated linearly with the duration of diabetes [21].…”

A Current Approach to Non-Alcoholic Steatohepatitis in Type 2 Diabetes Mellitus Patients

“…The role of platelets in the inflammatory process in NAFLD is well known, as they are included in numerous scores that evaluate the process of non-invasive fibrosis. Thus, a study that included 565 patients with NAFLD and diabetes, and aimed to highlight the factors that are associated with liver fibrosis in these patients, showed a statistically significant (p < 0.01) higher average value of platelets in NAFLD without liver fibrosis patients (a mean value of 226.000/mmc, with limits of 211.000-279.000/mm 3 ) compared to those with NAFLD and liver fibrosis (a mean value of 201.000/mmc, with limits of 173.500-238.000/mmc) [54]. Related to the characteristics of platelets, in our study, the average value of PDW was higher in the group of patients with HS and T2DM, compared to the group of patients with NASH and T2DM.…”