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. 2017 May;33(4).
doi: 10.1002/dmrr.2878. Epub 2017 Jan 27.

Occurrence over time and regression of nonalcoholic fatty liver disease in type 2 diabetes

Carlo Giorda  1 , Gabriele Forlani  2 , Roberta Manti  1 , Natalia Mazzella  2 , Salvatore De Cosmo  3 , Maria Chiara Rossi  4 , Antonio Nicolucci  4 , Giuseppina Russo  5 , Paolo Di Bartolo  6 , Antonio Ceriello  7   8 , Piero Guida  9 ; AMD-Annals Study Group  10
Affiliations

Occurrence over time and regression of nonalcoholic fatty liver disease in type 2 diabetes

Carlo Giorda et al. Diabetes Metab Res Rev. 2017 May.

Abstract

Background: This analysis was aimed to assess the incidence, regression, and correlated factors of nonalcoholic fatty liver disease (NAFLD) in type 2 diabetes, which are poorly known.

Methods: Nonalcoholic fatty liver disease (defined as fatty liver index [FLI] score ≥ 60) in patients with type 2 diabetes, and related factors was investigated in a nationwide database containing information from the Italian network of diabetes clinics. A 10% variation of FLI was the cut-off considered in the analyses of a cohort of 5030 patients, which was separately conducted for those who developed, maintained, or recovered from FLI-assessed NAFLD (FLI-NAFLD) over a 3-year period.

Results: At baseline, FLI-NAFLD was diagnosed in 61.3% of patients. Within the 3-year study period, FLI-NAFLD occurred in 313 patients and remitted in 410. The FLI score remained unchanged in 4307. Body-mass index (odds ratio, 1.45 95%; confidence interval, 1.35-1.55), abdominal obesity (2.11; 1.64-2.72), low HDL cholesterol levels (1.38; 1.02-1.87), and triglycerides (1.20; 1.12-1.28) all emerged as notable negative prognostic factors for the development or maintenance of FLI-NAFLD. The regression rate of FLI-NAFLD was higher among patients who managed to partially control these factors. Male sex and established organ damage, especially kidney function (1.64; 1.12-2.42), were independent risk predictors. Unlike other diabetes complications, FLI-NAFLD was more frequent among younger patients or those with a shorter duration of diabetes.

Conclusions: FLI-assessed NAFLD is a dynamic condition, with about 5% of diabetic patients entering or leaving the status every year. Younger male patients with insulin resistance or organ damage have a higher risk of presenting with FLI-NAFLD at baseline, developing FLI-NAFLD within 3 years, and a lower probability of regression.

Keywords: associated factors; hepatic steatosis; incidence; longitudinal analysis; recovery; type 2 diabetes.

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