Liver fibrosis indices are related to diabetic peripheral neuropathy in individuals with type 2 diabetes

Kim, Kyuho; Oh, Tae Jung; Cho, Hyen Chung; Lee, Yun Kyung; Ahn, Chang Ho; Koo, Bo Kyung; Moon, Jae Hoon; Choi, Sung Hee; Jang, Hak Chul

doi:10.1038/s41598-021-03870-z

Cited by 11 publications

(8 citation statements)

References 39 publications

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“…We found the positive association between NAFLD and PN in our study and maybe it is needed to explore whether NAFLD is associated with other microvascular complications in future studies. Another study 20 recruited 264 individuals with type 2 diabetes from Seoul, Korea. The study suggested that the NAFLD fibrosis score (NFS) and Fibrosis-4 (FIB-4) index were associated with DPN among patients with a high NAFLD liver fat score (> − 0.640).…”

Section: Discussionmentioning

confidence: 99%

Association between nonalcoholic fatty liver disease and peripheral neuropathy in US population, a cross-sectional study

Tang

Xuan

et al. 2023

Sci Rep

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Nonalcoholic fatty liver disease (NAFLD) has become an important risk of type 2 diabetes mellitus (T2DM). Peripheral neuropathy (PN) is regarded as one of the main microvascular complications of diabetes. But the association of NAFLD with PN is still unclear. We aimed to investigate the association between NAFLD and PN in US population by conducting a cross-sectional study. We enrolled 3029 participants aged 40–85 years from National Health and Nutrition Examination Survey (NHANES) 1999–2004. NAFLD was defined as a US Fatty Liver Index (FLI) score ≥ 30, and PN was defined as having one or more insensate areas on either foot. Participants were divided into two groups (with or without PN). We performed multivariate logistic regression models to evaluate the association between NAFLD and PN. Subgroup analyses were used to find out whether the association was stable in different stratified groups. Sensitivity analyses were conducted to assess the robustness of the results. All the analyses were weighted. Among the individuals, 524 (17.3%) had PN and 1250 (41.27%) had NAFLD. In the multivariate logistic regression models, NAFLD was associated with an increased risk of PN (OR 1.44 [1.03 ~ 2.02]) after fully adjusting for covariates. In the subgroup analyses, NAFLD was significantly associated with PN in the age group (40–64 years), compared with those in the age group (65–85 years), (P for interaction: 0.004). The results of association of NAFLD with PN were stable in sensitivity analyses. In this cross-sectional study among US adults aged 40–85 years old, NAFLD was associated with an increased likelihood of prevalent PN.

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Section: Discussionmentioning

confidence: 99%

Association between nonalcoholic fatty liver disease and peripheral neuropathy in US population, a cross-sectional study

Tang

Xuan

et al. 2023

Sci Rep

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“…In light of this data, our study supports the notion that the prevalence of severe fibrosis, the main determinant of mortality in NAFLD, is higher in patients with metabolic alterations. Other studies found a bidirectional correlation between liver fibrosis and peripheral diabetic neuropathy, suggesting possible common etiological mechanisms [ 47 , 48 , 49 ].…”

Section: Discussionmentioning

confidence: 95%

Clinical Model for the Prediction of Severe Liver Fibrosis in Adult Patients with Type II Diabetes Mellitus

et al. 2022

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Background and Objectives: Non-alcoholic fatty liver disease (NAFLD)-related severe liver fibrosis is associated with a higher risk of progressing to decompensated cirrhosis and hepatic failure and developing NAFLD-related hepatocellular carcinoma (HCC), particularly in populations with diabetes. Our pilot study aims to evaluate the performances of various noninvasive methods in predicting liver fibrosis in a population of patients with diabetes and to establish a new scoring system for the prediction of severe fibrosis (>F3). Materials and Methods: A total of 175 patients with diabetes were enrolled for liver fibrosis evaluation. Using the degree of agreement (concordance) between a noninvasive score based on serum biomarkers (NAFLD fibrosis score) and point shear-wave elastography (pSWE) as the reference method, we generated receiver operating characteristic (ROC) curves and performed a multivariate analysis to predict severe liver fibrosis. Results: In our population of patients with diabetes, gamma-glutamyltransferase (GGT), age, body mass index (BMI), the homeostatic model assessment of insulin resistance (HOMA-IR), and glycosylated hemoglobin (HbA1C) were significant predictors for the diagnosis of the F3/F4 group (area under the ROC: 0.767, 0.743, 0.757, 0.772, and 0.7, respectively; p < 0.005 for all). Moreover, the combined composite score (the sum of GGT, age, BMI, HOMA index, and HbA1C) had the highest diagnostic performance at a cut-off value of 3 (AUROC—0.899; p < 0001). The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were 91.20%, 79%, 79%, and 89%, respectively, and 89% of patients were correctly classified as having severe liver fibrosis. In contrast with the Fibrosis 4 (FIB-4) score and the AST-to-platelet ratio index (APRI), the composite score had the best accuracy in discriminating advanced fibrosis. Conclusions: The proposed composite score had a reliable and acceptable diagnostic accuracy in identifying patients with diabetes at risk of having severe fibrosis using readily available laboratory and clinical data.

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“…As mentioned earlier, AAR, an emerging indicator of liver function, has been reported to effectively predict the severity of liver fibrosis in patients with various liver disease including NAFLD (10,11). There is now growing evidence that NAFLD is more common and often advanced in patients with T2DM, easily progressing to nonalcoholic steatohepatitis and advanced liver fibrosis, than in the general population (6,(43)(44)(45)(46). Considering a certain intrinsic correlation among AAR, NAFLD and liver fibrosis, and diabetic vascular complication (6,10,11,(15)(16)(17)(18)(19)(43)(44)(45)(46), it is plausible that AAR may be associated with the presence of DPN, and high AAR may be an early signal for being at risk for DPN.…”

Section: Discussionmentioning

confidence: 99%

“…There is now growing evidence that NAFLD is more common and often advanced in patients with T2DM, easily progressing to nonalcoholic steatohepatitis and advanced liver fibrosis, than in the general population (6,(43)(44)(45)(46). Considering a certain intrinsic correlation among AAR, NAFLD and liver fibrosis, and diabetic vascular complication (6,10,11,(15)(16)(17)(18)(19)(43)(44)(45)(46), it is plausible that AAR may be associated with the presence of DPN, and high AAR may be an early signal for being at risk for DPN. In the present study, we found that patients with higher AAR quartiles tended to have higher VPT, a widely recommended indicator of the presence and severity of confirmed clinical neuropathy (47), and similarly, patients with DPN had significantly higher AAR than those without.…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies have shown that type 2 diabetes mellitus (T2DM) is an independent risk factor for the development of nonalcoholic fatty liver disease (NAFLD) and progression to liver fibrosis and cirrhosis (4,5). Also, NAFLD and liver fibrosis have been reported to play an important role in the presence and progression of DPN (6)(7)(8). Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were the two most common liver enzymes that reflect hepatocellular injury and death, and liver function.…”

Section: Introductionmentioning

confidence: 99%

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Aspartate aminotransferase/alanine aminotransferase ratio was associated with type 2 diabetic peripheral neuropathy in a Chinese population: A cross-sectional study

Yan

Dan

et al. 2023

Front. Endocrinol.

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ObjectiveDespite previous research that focused on aspartate aminotransferase/alanine aminotransferase ratio (AAR) as predictors of type 2 diabetes mellitus (T2DM) and cardiovascular disease, there has been limited research evaluating the association between AAR and diabetic microvascular complications. This study aimed to investigate the association of AAR with diabetic peripheral neuropathy (DPN).MethodsA total of 1562 hospitalized patients with T2DM were divided into four groups according to AAR quartiles. The relationship between AAR and DPN and related parameters was explored by the Spearman correlation coefficients, multivariable logistic regression analysis, and receiver operating characteristic (ROC) curves.ResultsPatients with higher AAR quartiles had higher levels of vibration perception threshold (VPT) and presence of DPN, and AAR was positively associated with VPT and presence of DPN independent of sex, age, body mass index, and diabetic duration (P<0.01 or P<0.05). Moreover, AAR remained significantly associated with a higher odds ratio (OR) of DPN (OR 2.413, 95% confidence interval [CI] 1.081-5.386, P<0.05) after multivariate adjustment. Additionally, the risk of presence of DPN increased progressively as AAR quartiles increased (all P for trend <0.01) in both male and female subjects, and the highest quartile of AAR of male and female subjects was respectively associated with 107.3% (95% CI: 1.386-3.101; P<0.01) and 136.8% (95% CI: 1.550-3.618; P<0.01) increased odds of DPN compared with the lower quartiles. Last, the analysis of receiver operating characteristic curves revealed that the best cutoff values for AAR to predict the presence of DPN were 0.906 (sensitivity: 70.3%; specificity: 49.2%; and area under the curve [AUC]: 0.618) and 1.402 (sensitivity: 38%; specificity: 81.9%; and AUC: 0.600) in male and female subjects, respectively.ConclusionsThese findings suggest that the high AAR may be associated with the presence of DPN in Chinese patients with T2DM, and may be used as an additional indicator of risk of DPN.

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Liver fibrosis indices are related to diabetic peripheral neuropathy in individuals with type 2 diabetes

Cited by 11 publications

References 39 publications

Association between nonalcoholic fatty liver disease and peripheral neuropathy in US population, a cross-sectional study

Association between nonalcoholic fatty liver disease and peripheral neuropathy in US population, a cross-sectional study

Clinical Model for the Prediction of Severe Liver Fibrosis in Adult Patients with Type II Diabetes Mellitus

Aspartate aminotransferase/alanine aminotransferase ratio was associated with type 2 diabetic peripheral neuropathy in a Chinese population: A cross-sectional study

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