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...

Nonalcoholic fatty liver disease (NAFLD) is closely correlated to several metabolic syndrome features. We assessed prospectively whether NAFLD predicts future cardiovascular disease (CVD) events among type 2 diabetic individuals, independent of metabolic syndrome features and other classical risk factors. We carried out a prospective nested case-control study in 2,103 type 2 diabetic patients who were free of diagnosed CVD at baseline. During 5 years of follow-up, 248 participants (case subjects) subsequently developed nonfatal coronary heart disease (myocardial infarction and coronary revascularization procedures), ischemic stroke, or cardiovascular death. Using risk-set sampling, 496 patients (control subjects) among those who remained free of diagnosed CVD during follow-up were randomly selected in a 2:1 ratio, matched for age and sex to the case subjects. After adjustment for age, sex, smoking history, diabetes duration, HbA 1c , LDL cholesterol, liver enzymes, and use of medications, the presence of NAFLD was significantly associated with an increased CVD risk (odds ratio 1.84, 95% CI 1.4 -2.1, P < 0.001). Additional adjustment for the metabolic syndrome (as defined by National Cholesterol Education Program Adult Treatment Panel III criteria) appreciably attenuated, but did not abolish, this association (1.53, 1.1-1.7, P ‫؍‬ 0.02). In conclusion, NAFLD is significantly associated with a moderately increased CVD risk among type 2 diabetic individuals. This relationship is independent of classical risk factors and is only partly explained by occurrence of metabolic syndrome. Diabetes 54: [3541][3542][3543][3544][3545][3546] 2005 N onalcoholic fatty liver disease (NAFLD) is currently the most common abnormality observed in hepatology practice. NAFLD is a clinicopathologic syndrome that is closely correlated to visceral obesity, dyslipidemia, insulin resistance, and type 2 diabetes, thus suggesting that NAFLD is another feature of the metabolic syndrome (1-4).A great deal of evidence suggests that the metabolic syndrome predicts incident cardiovascular disease (CVD) (5-8), so it is possible to hypothesize that NAFLD patients might portend a greater CVD risk and that NAFLD itself might confer a CVD risk above that associated with individual metabolic syndrome risk factors. Recent crosssectional studies have clearly documented that patients with NAFLD have, other than several features resembling the metabolic syndrome, a markedly greater carotid artery wall thickness than those without NAFLD (9,10). This finding was also validated by the results of a large population-based study (11). However, carotid artery wall thickness is only a marker of early generalized atherosclerosis (12), so currently it is uncertain whether NAFLD is significantly associated with increased risk of future CVD events. Clarification of this aspect may help to explain the underlying mechanisms and may be of clinical importance for undertaking preventive and therapeutic strategies. We have, therefore, assessed prospectively in a large sam...

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The prevalence of CVD is increased in patients with Type 2 diabetes and NAFLD in association with an increased prevalence of MetS as compared with diabetic patients without NAFLD. Follow-up studies are necessary to determine whether this higher prevalence of CVD among diabetic patients with NAFLD affects long-term mortality.

These results indicate that 1) diabetes is characterized by a greater thickness of the carotid artery independently of other established risk factor of atherosclerosis, 2) early atherosclerosis is independently associated with insulin resistance in diabetic but not in nondiabetic patients, 3) central adiposity is an independent predictor of IMT in nondiabetic individuals.