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. 2015 Mar;3(1):9-16.
doi: 10.14218/JCTH.2015.00001. Epub 2015 Mar 15.

Diabetes Mellitus Predicts Occurrence of Cirrhosis and Hepatocellular Cancer in Alcoholic Liver and Non-alcoholic Fatty Liver Diseases

Evan J Raff  1 , Donny Kakati  1 , Joseph R Bloomer  2 , Mohamed Shoreibah  2 , Khalid Rasheed  3 , Ashwani K Singal  2
Affiliations

Diabetes Mellitus Predicts Occurrence of Cirrhosis and Hepatocellular Cancer in Alcoholic Liver and Non-alcoholic Fatty Liver Diseases

Evan J Raff et al. J Clin Transl Hepatol. 2015 Mar.

Abstract

Background and aims: Alcohol abuse and nonalcoholic fatty liver disease (NAFLD) are common causes of liver disease. Diabetes mellitus (DM) is a common comorbidity among NAFLD patients. We performed this study with the specific aim to examine the impact of DM on progression of alcoholic liver disease (ALD) liver and NAFLD.

Methods: Medical charts of 480 patients with ALD or NAFLD (2004-2011) managed at a tertiary center were retrospectively reviewed. NAFLD was diagnosed based on exclusion of other causes of liver disease and alcohol use of <10 g/d. ALD was diagnosed based on alcohol use of >40 g/d in women or >60 g/d in men for >5 years.

Results: Of 480 patients (307 NAFLD), 200 diabetics differed from nondiabetics for: age (52±11 vs. 49±11 years; p=0.004); male gender (48% vs. 57%; p=0.03); metabolic syndrome (49% vs. 30%; p=0.0002); NAFLD (80% vs. 56%; p<0.0001); cirrhosis (70% vs. 59%; p=0.005); and hepatocellular carcinoma (HCC; 8% vs. 3%; p=0.009). Over a 3 year median follow-up period, diabetics relative to nondiabetics had a higher probability to develop cirrhosis (60% vs. 41%; p=0.022) and HCC (27% vs. 10%; p=0.045). There was a trend for increased development of hepatic encephalopathy in diabetics compared to nondiabetics (55% vs. 39%; p=0.053), and there was no difference between the two groups in survival or other liver disease complications.

Conclusions: DM increased risk for cirrhosis and HCC among patients with ALD and NAFLD. Prospective studies with longer follow-up periods are needed to examine the impact of DM on survival and the role of aggressive HCC screening in diabetic cirrhotics.

Keywords: Alcoholic cirrhosis; Diabetes mellitus; Nonalcoholic steatohepatitis; Steatohepatitis.

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Conflict of interest statement

Conflict of interest: None

Figures

Fig. 1
Fig. 1. Study population.
Fig. 2
Fig. 2. Histologic findings in liver biopsies among patients with alcoholic liver disease (ALD) or nonalcoholic fatty liver disease (NAFLD) and with or without diabetes.
Fig. 3
Fig. 3. Cumulative probability of developing cirrhosis in diabetics and nondiabetics in patients with alcoholic liver or non-alcoholic fatty liver diseases.
The probability of developing cirrhosis is higher among diabetics.
Fig. 4
Fig. 4. Cumulative probability of developing hepatocellular carcinoma (HCC) in diabetics and nondiabetics in patients with alcoholic liver or non-alcoholic fatty liver diseases.
Results show that the probability of developing HCC is higher among diabetics.
See this image and copyright information in PMC

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