Non-invasive Assessment of Liver Steatosis and Fibrosis Using Transient Elastography and Controlled Attenuation Parameter in type 2 Diabetes Patients

Abstract

Context. Nonalcoholic fatty liver disease is common in type 2 diabetes mellitus patients, being difficult to diagnose.Objective. To find a correlation between elastographic parameters and lab results, for facilitating the diagnosis of nonalcoholic fatty liver disease.Design. This is a cross sectional study, conducted at the Departments of Diabetes, Nutrition and Metabolic Diseases, and Gastroenterology and Hepatology, of the Clinical Emergency Hospital "Pius Brinzeu" Timisoara.Subjects and Methods. We included 190 type 2 diabetes mellitus patients, collected data regarding medical history, clinical and biological features and applied the Alcohol Use Disorders Identification Test. We excluded patients with other causes of liver disease. Liver steatosis and fibrosis were evaluated through transient elastography, yielding two parameters: liver stiffness as an indicator of liver fibrosis stage, expressed in kPa, and liver steatosis stage, assessed by controlled attenuation parameter, expressed in dB/m. Data were analyzed using SPSS 15.Results. The analyzed group comprised 113 patients. Elastographic measurements showed that 93.8% of the patients had steatosis (controlled attenuation parameter ≥232.5 dB/m) and 70.8% severe steatosis (controlled attenuation parameter ≥290 dB/m). Severe steatosis was more common in women (75.7%) than in men (68.1%) (p<0.0001). From the patients with steatosis, 47.2% had liver stiffness values suggestive for fibrosis and 19.8% for cirrhosis. Most patients with steatosis and severe fibrosis were obese (66.7%). Triglycerides/HDLc ratio >4 correlated with hepatic steatosis (p=0.04), being more common in patients with severe fibrosis/cirrhosis (58.3%) than in those with absent or mild fibrosis (36.2%).Conclusions. Our study found a clear correlation between type 2 diabetes mellitus and the presence of liver steatosis. It correlates with body mass index, waist circumference (in men) and triglycerides/HDLc ratio. Controlled attenuation parameter is a useful noninvasive method for detection and quantification of liver steatosis.

Prevalence of advanced liver fibrosis and steatosis in type-2 diabetics with normal transaminases: A prospective cohort study

“…Prevalence of F4 stage fibrosis defined as liver stiffness > 9.5 kPA in another study from Romania was 18.6%. However, like most of the other studies, they too included patients with elevated ALT, with a significant number of patients having an ALT more than 40 U/L[ 23 ]. Currently, it is not the standard of care to assess liver fibrosis using liver biopsy in patients with normal ALT levels.…”

The epidemiology and characteristics of patients with diabetes with or without NASH: a systematic review

“…Among adults, females with diabetes were most frequently diagnosed with NASH 20 , 21 . Nevertheless, this likely signifies a bias that females are more likely to go to the healthcare professionals than males (henceforth, get diagnosed with NAFLD/NASH).…”

Transient elastography for the prevalence of non-alcoholic fatty liver disease in patients with type 2 diabetes

“…reported steatosis in 93.8% of patients with CAP ≥232.5 dB/m and severe steatosis in 70.8% of patients with CAP ≥290 dB/m. [ 20 ] The observed variations between studies might have occurred due to differences in our cutoff values for CAP for the diagnosis of NAFLD. Notably, the prevalence of NAFLD in our cohort was higher than previous reports, ranging from 47.8% (95% CI, 41.1%–54.6%) to 72.8% (95% CI, 66.6%–78.1%) in Saudi patients with T2DM.…”

“…[ 14 15 ] The prevalence of steatosis and fibrosis using transient elastography has been assessed by multiple prospective cohort studies. [ 16 17 18 19 20 ]…”