Prevalence of Nonalcoholic Fatty Liver Disease and Its Association With Cardiovascular Disease Among Type 2 Diabetic Patients

Abstract

OBJECTIVE -To determine the prevalence of nonalcoholic fatty liver disease (NAFLD) in type 2 diabetic population and to compare the prevalence of cardiovascular disease (CVD) and its risk factors between people with and without NAFLD.RESEARCH DESIGN AND METHODS -The entire sample of type 2 diabetic outpatients (n ϭ 2,839) who regularly attended our clinic was screened. Main outcome measures were NAFLD (by patient history and liver ultrasound) and manifest CVD (by patient history, review of patient records, electrocardiogram, and echo-Doppler scanning of carotid and lower limb arteries).RESULTS -The unadjusted prevalence of NAFLD was 69.5% among participants, and NAFLD was the most common cause (81.5%) of hepatic steatosis on ultrasound examination. The prevalence of NAFLD increased with age (65.4% among participants aged 40 -59 years and 74.6% among those aged Ն60 years; P Ͻ 0.001) and the age-adjusted prevalence of NAFLD was 71.1% in men and 68% in women. NAFLD patients had remarkably (P Ͻ 0.001) higher age and sex-adjusted prevalences of coronary (26.6 vs. 18.3%), cerebrovascular (20.0 vs. 13.3%), and peripheral (15.4 vs. 10.0%) vascular disease than their counterparts without NAFLD. In logistic regression analysis, NAFLD was associated with prevalent CVD independent of classical risk factors, glycemic control, medications, and metabolic syndrome features.CONCLUSIONS -NAFLD is extremely common in people with type 2 diabetes and is associated with a higher prevalence of CVD. Follow-up studies are needed to determine whether NAFLD predicts the development and progression of CVD. Diabetes Care 30:1212-1218, 2007N onalcoholic fatty liver disease (NAFLD) is the most common cause of abnormal liver function tests among adults in Western countries (1-4). The spectrum of NAFLD ranges from simple steatosis to nonalcoholic steatohepatitis (NASH), which can progress to end-stage liver disease. NAFLD is commonly associated with obesity, type 2 diabetes, dyslipidemia, and insulin resistance, all of which are components of the metabolic syndrome, strongly supporting the notion that NAFLD is the hepatic manifestation of the syndrome (1-4). The prevalence of NAFLD has been reported to be in the 15-30% range in the general population in various countries (5-7) and is almost certainly increasing. Accordingly, a huge number of individuals are at risk of developing advanced liver disease.Compared with nondiabetic subjects, people with type 2 diabetes appear to have an increased risk of developing NAFLD and certainly have a higher risk of developing fibrosis and cirrhosis (1-4). It has been estimated that ϳ70 -75% of type 2 diabetic patients may have some form of NAFLD (8); however, the "precise" prevalence of NAFLD in type 2 diabetes is unknown. The few available studies have been small and performed in highly selected populations or have estimated only the prevalence of abnormal aminotransferase levels (9 -12), which are a poor proxy measure of NAFLD (1-3).Recent data suggest that the presence of NAFLD in type 2 diabetes may also...

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