Hepatic steatosis in diabetic patients does not predict adverse liver‐related or cardiovascular outcomes

Abstract

Although steatosis on imaging is often the abnormality that triggers diagnosis and assessment of NAFLD/NASH, it lacks predictive value for adverse clinical outcomes.

Prognostic Value of Non-Invasive Fibrosis and Steatosis Tools, Hepatic Venous Pressure Gradient (HVPG) and Histology in Nonalcoholic Steatohepatitis

“…In primary and secondary care facilities, simple serum biomarkers can help targeting patients with an established diagnosis of NASH who need expedited referral to tertiary care centers. In line with previous histologic and imaging studies, we also showed that non-invasive diagnostic tools for hepatic steatosis lack predictive value for clinical outcomes in patients with NASH [10,32,33]. …”

“…In a US community-based cohort study of 337 type 2 diabetic patients, a histologic or ultrasonographic diagnosis of NAFLD had a HR of 2.2 to predict overall mortality and NAFLD was associated with significantly higher mortality caused by liver disease and malignancy [13]. However, a study of 2342 type 2 diabetic patients concluded that steatosis >30% lacks predictive value for adverse clinical outcomes [33]. Our finding is in line with histologic paired biopsy studies which showed that steatosis alone is a weaker predictor for progressive NASH than liver fibrosis stage [32].…”

An association of large-fibre peripheral nerve dysfunction with non-invasive measures of liver fibrosis secondary to non-alcoholic fatty liver disease in diabetes

“…Our findings support the emerging notion that simple steatosis secondary to NAFLD may not be associated with significantly increased risk of peripheral neuropathy or other diabetes specific complications but that NASH, in particular with fibrosis, is associated (Dunn et al, 2013;Kim, Kim, Kim, & Therneau, 2013;Kim, Jung, Mok, Kang, & Kim, 2014;Musso et al, 2014;Williams et al, 2013). Indeed, in regard to the relationship between peripheral neuropathy and steatosis on ultrasound, our data are consistent with a South Korean study that found no association (Kim et al, 2014).…”

Non-alcoholic fatty liver disease and risk of cardiovascular disease

“…Table 1 summarizes the retrospective and prospective studies that have assessed the relationship between NAFLD and the risk of CVD events and mortality [17,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Most of these studies support the assertion that CVD is the most common cause of mortality among patients with NAFLD.…”

“…Regarding the imaging-diagnosed NAFLD [17,[26][27][28][29][30][31][32][33][34][35][36], several retrospective and prospective cohort studies have shown that NAFLD was associated with an increased incidence of major CVD events, independently of traditional risk factors and MetS traits. In contrast, and surprisingly, using data from the Third National Health and Nutrition Examination Survey database, the investigators…”