Nonalcoholic fatty liver disease (NAFLD) in nonobese patients with diabetes: Prevalence and relationships with hemodynamic alterations detected with Doppler sonography

Abstract

Aim: To evaluate the prevalence, severity, and hemodynamic features of nonalcoholic fatty liver disease (NAFLD) in nonobese diabetics. Methods: We studied 100 consecutive nonobese (body mass index [BMI] < 30) patients with type 1 (n Z 17) or type 2 (n Z 83) diabetes and no known causes of liver disease. Steatosis was diagnosed and graded with ultrasonography. Digital sonographic images of the liver and right kidney were analyzed with dedicated software (HDI-Lab), and the liver/kidney ratio of grey-scale intensity was calculated as an index of the severity of the steatosis. Severity scores ranging from 0 (none) to 5 (severe) were compared with sonographic and Doppler findings (right liver size, portal vein diameter and flow velocity, hepatic and splenic arterial pulsatility indices, hepatic-vein flow profile and A-and S-wave velocities). Results: The prevalence of steatosis was 24% in type I and 80% in type II diabetes (grade 1 in 17%, grade 2 in 34%, grade 3 in 33%, grade 4 in 9%, grade 5 in 7%). In patients with steatosis (especially those with grades 4e5 disease), hepatic volume was increased (p < 0.005). Portal vein diameter was increased in grade 5 steatosis. The hepatic artery pulsatility index was significantly increased, particularly in grades 4 and 5 (p < 0.0001); portal and A-wave velocities were significantly reduced in grades 3e5 (p < 0.001); and the hepatic vein flow profile was altered in 27% (biphasic: 20%, flat: 7%) patients with steatosis, although there was no correlation with severity. Conclusions: NAFLD is very frequent in nonobese diabetics with type 2 but not type 1 disease, and it is associated with hepatomegaly and liver hemodynamic alterations only when it is severe.

Role of Colour Doppler in Evaluation of Hemodynamic Changes in Chronic Hepatitis C Infection

“…Nontriphasic flow was appreciated in patients with increased liver echogenicity. 15 This result is also in concordant with previous observations. Although HARI and HAPI is not calculated in this study, some international studies suggests that these parameters were significantly greater in patients with moderate or severe inflammation than those with mild inflammation in controlled studies.…”

Hepatic artery resistive index (HARI) and non-alcoholic fatty liver disease (NAFLD) fibrosis score in NAFLD patients: cut-off suggestive of non-alcoholic steatohepatitis (NASH) evolution

“…Data of previous studies suggest that clues of AST aspartate aminotransferase, ALT alanine aminotransferase * Student T test steatohepatitis in NAFLD patients can be an increase in portal vein diameter, reduction of portal vein velocity, large splenic area, and an increase in RI of splenic artery [10,15,16]. In our baseline, similar characteristics were found in NAFLD patients with severe fatty liver disease (Table 2).…”

“…Although the traditional ultrasound (US) is an excellent diagnostic technique to reveal the presence of diffuse fatty liver disease, it is neither sensitive nor specific to reveal fibrosis, except in advanced stages where signs of cirrhosis are evident. Previous studies have demonstrated that hepatic artery resistive index (HARI) is significantly altered in patients with NAFLD, with significant reduction of this parameter with increasing of severity of diffuse fatty liver disease [7][8][9][10].…”

Hepatic Steatosis in Type 1 Diabetes

“…A study of 17 patients with type 1 diabetes aged 65 ± 7 years detected hepatic steatosis in 24% of them, noting that patients with fatty livers had higher body mass indexes than their counterparts without steatosis [73]. Targher et al observed fatty liver in 44.4% of a sample of 202 type 1 diabetes patients.…”