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...

OBJECTIVE -Nonalcoholic fatty liver disease (NAFLD) is closely associated with several metabolic syndrome features. We assessed whether NAFLD is associated with carotid artery intima-media thickness (IMT) as a marker of subclinical atherosclerosis and whether such an association is independent of classical risk factors, insulin resistance, and metabolic syndrome features. RESEARCH DESIGN AND METHODS-We compared carotid IMT, as assessed by ultrasonography, in 85 consecutive patients with biopsy-proven NAFLD and 160 age-, sex-, and BMI-matched healthy control subjects.RESULTS -NAFLD patients had a markedly greater carotid IMT (1.14 Ϯ 0.20 vs. 0.82 Ϯ 0.12 mm; P Ͻ 0.001) than control subjects. The metabolic syndrome (according to Adult Treatment Panel III criteria) and its individual components were more frequent in those with NAFLD (P Ͻ 0.001). The marked differences in carotid IMT observed between the groups were only slightly weakened after adjustment for age, sex, BMI, smoking history, LDL cholesterol, insulin resistance (by homeostasis model assessment), and metabolic syndrome components. Notably, carotid IMT was strongly associated with degree of hepatic steatosis, necroinflammation, and fibrosis among NAFLD patients (P Ͻ 0.001 for all). Similarly, by logistic regression analysis, the severity of histological features of NAFLD independently predicted carotid IMT (P Ͻ 0.001) after adjustment for all potential confounders.CONCLUSIONS -These results suggest that the severity of liver histopathology among NAFLD patients is strongly associated with early carotid atherosclerosis, independent of classical risk factors, insulin resistance, and the presence of metabolic syndrome. Diabetes Care 29:1325-1330, 2006N onalcoholic fatty liver disease (NAFLD), the most common cause of abnormal liver function tests in hepatology practice, is frequently associated with visceral obesity, dyslipidemia, insulin resistance, and type 2 diabetes and may represent another component of the metabolic syndrome (1-3).Recent cross-sectional studies (4 -6) have shown that NAFLD is associated with increased carotid artery intimamedia thickness (IMT), a marker of early generalized atherosclerosis (7). However, in these studies the NAFLD diagnosis was exclusively based on ultrasound imaging but was not confirmed by liver biopsy, which is the best diagnostic tool for confirming NAFLD (1-3).Thus, currently it is uncertain whether there is a significant association between early carotid atherosclerosis and the severity of liver histology among NAFLD patients. Clarification of this aspect may help to explain the underlying mechanisms and may be of clinical importance in planning preventive and therapeutic strategies.We have, therefore, assessed whether patients with biopsy-proven NAFLD have a greater carotid IMT than control subjects and whether there is a significant association between liver histology and carotid IMT among NAFLD patients. RESEARCH DESIGN ANDMETHODS -A total of 85 consecutive outpatients with NAFLD were recruited from clinics, 50...

Hypovitaminosis D is highly prevalent in type 2 diabetic adults and is strongly and independently associated with increased carotid IMT. Further investigation into whether vitamin D may play a role in the prevention of atherosclerosis appears to be warranted.

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