Prevalence of clinically relevant liver fibrosis due to nonalcoholic fatty liver disease in Indian individuals with type 2 diabetes

Abstract

Background and Aim Type 2 diabetes (T2D) in associated with higher prevalence and worse outcomes of nonalcoholic fatty liver disease (NAFLD). However, data regarding the prevalence of clinically relevant liver fibrosis (CRLF) in Indian individuals with T2D are scarce. We investigated the prevalence of, and factors associated with, CRLF in Indians with T2D. Methods We conducted a prospective study of 601 consecutive adults with T2D. Steatosis was diagnosed using ultrasonography. Liver stiffness measurement (LSM) by transient elastography of ≥8.0 kPa was taken as cutoff suggesting CRLF. Individuals with LSM > 13.0 kPa underwent dynamic magnetic resonance imaging (MRI) of liver for detecting changes consistent with cirrhosis. Results The prevalence of steatosis was 84.2%. Higher body mass index (BMI, P = 0.022), alanine aminotransferase (ALT; P = 0.001), and lower high‐density lipoprotein (HDL; P = 0.002) were independent factors associated with steatosis. The prevalence of CRLF was 28.2%. Higher BMI (P = 0.001), aspartate aminotransferase (AST; P < 0.0001), gamma‐glutamyl transpeptidase (GGT; P < 0.0001), and concomitant hypertension (P = 0.03) were independent factors associated with CRLF. Elevated ALT and AST (≥40 units/L) levels were present in 70.6 and 51.6% individuals with CRLF, respectively. Thirty‐one (7.2%) individuals had LSM > 13.0 kPa. Among them, 25 individuals underwent dynamic MRI of liver, which revealed features consistent with cirrhosis in 18 patients. Conclusion CRLF, an established risk factor for cirrhosis and overall mortality, affects at least one out of four (25%) Indians with T2D. These results support screening of all patients with T2D and NAFLD for liver fibrosis.

Diagnostic Accuracy and Optimal Cut-off of Controlled Attenuation Parameter for the Detection of Hepatic Steatosis in Indian Population

“…[1][2][3][4] Hepatic steatosis, the earliest stage of NAFLD spectrum, remains broadly underdiagnosed and has a potential to progress to hepatic fibrosis and cirrhosis. [5][6][7] Liver biopsy is the currently available gold standard method for diagnosis of steatosis and other NAFLD-related pathological conditions as routinely available imaging is not able to diagnose mild steatosis or non-alcoholic steatohepatitis. [8][9] However, liver biopsy is invasive, needs hospitalization and there is risk of adverse events.…”

Prevalence of High and Moderate Risk of Liver Fibrosis Among Patients With Diabetes at a Noncommunicable Diseases (NCD) Clinic in a Primary Healthcare Center in Northern India

“…For instance, a study conducted by Sinha and Bankura, using transient elastography, found the risk of moderate-to-severe liver fibrosis to be 32% [12]. Another study within the population with diabetes in India indicated a prevalence of clinically relevant liver fibrosis at 28% [13].…”

Diagnostic Value of Non-invasive Liver Function Tests in Liver Fibrosis and Changes in These Parameters Post-metabolic Surgery

“…Furthermore, triglyceride accumulation, as a hallmark of NAFLD, may be one predictor of the development of NAFLD in later life [13,14]. In response to hepatocellular damage, there is a proportional release of ALT into the circulation, which is thought to be a sensitive marker of liver injury and disease progression.…”