Non-alcoholic fatty liver disease and type 2 diabetes mellitus: issues of the liver fibrosis diagnostics

Abstract

Aim. To evaluate the frequency of liver fibrosis progression to stage 34 among patients with non-alcoholic fatty liver disease (NAFLD), type 2 diabetes and obesity, to identify predictors of severe liver fibrosis, to propose an algorithm for diagnosing fibrosis in this category of patients.
 Materials and methods. 160 patients with NAFLD, type 2 diabetes mellitus (DM) and obesity and 50 patients with NAFLD without diabetes were comprehensively examined. Patients underwent laboratory examination (clinical blood test, biochemical analysis, immunoglobulins G, M, autoantibody assay, coagulogram), liver ultrasound. All patients underwent determination of the liver fibrosis stage by two methods: the serological test FibroMax and indirect ultrasound elastometry of the liver; 40 patients underwent a liver biopsy. Statistical data processing was performed using the programming language and statistical calculations R: we used correlation analysis, multiple logistic regression method, one-way analysis of variance, multi-factor analysis, the Kruskal-Wallis method, and comparison of the number of patients using the Fisher test.
 Results. DM is a risk factor for the liver fibrosis progression in patients with NAFLD. Significant markers of severe fibrosis in this category of patients are increased levels of GGTP, haptoglobin and alpha-2-macroglobulin, lower platelet and prothrombin levels. Obesity and isolated steatosis without steatohepatitis are not markers of severe liver fibrosis at present, but obesity can be considered a risk factor for the progression of fibrosis in the future.
 Conclusion. All patients with NAFLD in combination with diabetes need screening to detect advanced liver fibrosis: it is advisable to determine the levels of GGTP, haptoglobin and alpha-2-macroglobulin.

Clinical Interest of Serum Alpha-2 Macroglobulin, Apolipoprotein A1, and Haptoglobin in Patients with Non-Alcoholic Fatty Liver Disease, with and without Type 2 Diabetes, before or during COVID-19

“…Here, in patients at risk of NAFLD, haptoglobin levels were positively associated with male sex, T2DM, and obesity, and surprisingly with the grade of steatosis in non-obese men, in univariate and multivariate analyses. These associations are in line with a chronic inflammation profile in these patients before the onset of histological NASH [54][55][56][57][58][59][60][61].…”

“…In patients at risk of NAFLD, haptoglobin is increased in obese patients with T2DM but decreased in patients who progress to advanced fibrosis [61]. No study thus far has assessed the respective impacts of elementary histological features (steatosis, NASH inflammatory activity, and fibrosis) adjusted according to T2DM and obesity on serum haptoglobin.…”

Patient Management in Non-Alcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus

“…Вопросы эпидемиологии НАЖБП рассматривается в настоящее время как наиболее частое среди заболеваний печени. Распространенность НАЖБП в общей популяции взрослых в мире составляет 20-30 %; она варьирует в зависимости от используемых методов диагностики, пола, возраста и этнической принадлежности [3,6,9,16,17]. Считается, что частота НАЖБП среди мужчин примерно в 2 раза выше в сравнении с женщинами; она увеличивается с возрастом; ниже у лиц африканского и азиатского происхождения (13-20 %) и выше -у европеоидных жителей Европы, Северной Америки и Ближнего Востока (25-32 %) [7,18].…”