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. 2021 Jun 29;5(8):915-922.
doi: 10.1002/jgh3.12606. eCollection 2021 Aug.

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

Mohammad Shafi Kuchay  1 , Narendra Singh Choudhary  2 , Sunil Kumar Mishra  1 , Tarannum Bano  1 , Sakshi Gagneja  1 , Anu Mathew  1 , Manish Kumar Singh  3 , Parjeet Kaur  1 , Harmandeep Kaur Gill  1 , Jasjeet Singh Wasir  1 , Randhir Sud  2 , Ambrish Mithal  1
Affiliations

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

Mohammad Shafi Kuchay et al. JGH Open. .

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.

Keywords: FibroScan; cirrhosis; clinically relevant liver fibrosis; nonalcoholic fatty liver disease; steatosis.

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Figures

Figure 1
Figure 1
Derivation of the study cohort. LSM, liver stiffness measurement; NAFLD, nonalcoholic fatty liver disease; T2D, type 2 diabetes; USG, ultrasonography.
See this image and copyright information in PMC

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