Prevalence of non-alcoholic fatty liver disease and its associated factors in individuals with type 1 diabetes: a cross-sectional study in a tertiary care center in Brazil

Abstract

Background Data on non-alcoholic fatty liver disease (NAFLD) in individuals with type 1 diabetes (T1D) is controversial and so far, there are no published data on the Brazilian population. We investigated the prevalence of steatosis and hepatic fibrosis in a population with T1D from a tertiary care center in Brazil and its associated factors. Methods Ninety-five participants with T1D, aged 39 ± 13 years, with disease duration of 21 ± 9 years, being 55 (57.9%) females, from a university hospital in Rio de Janeiro, were screened for NAFLD with hepatic ultrasound (US) and transient elastography (TE). Results Prevalence of steatosis was, respectively, 12.6% and 16.8% when US and TE were used for diagnosis of NAFLD. Fibrosis was present in 8.4% of participants. A total of 31.6% of participants had at least one of the hepatic exams altered, which was associated with higher body mass index, waist circumference, hip circumference and waist-to-hip ratio,, presence of metabolic syndrome and higher triglycerides levels, even within the normal range. After multivariate analysis, presence of steatosis was only associated with metabolic syndrome and its component, triglycerides. Conclusion In our study, prevalence of NAFLD in ultrasound approximates the one found with TE. Fibrosis was not frequent. Screening should be reserved for participants with T1D and metabolic syndrome, as this was the main factor associated with NAFLD. Triglycerides levels were the only component of metabolic syndrome associated with steatosis. Further studies are necessary to determine the best screening strategy for NAFLD in individuals with T1D. Also, predisposing factors for development in fibrosis in T1D should be further explored in prospective studies.

Mitochondrial Mutations and Genetic Factors Determining NAFLD Risk

“…Focusing on the different types of DM, we can notice that linkage between NAFLD and DM1T is not so pronounced and depends greatly on the diagnostic strategy (ultrasound, magnetic resonance imaging, biopsy, or transient elastography) with a pooled prevalence of 19.3–22% in adults [ 195 ]. Similar results were obtained for the Brazilian population, where NAFLD was diagnosed among DM1T patients with hepatic ultrasound and transient elastography and resulted in 12.6% and 16.8% prevalence, respectively [ 196 ]. In contrast, the risk of DM2T and MetS among NAFLD patients was increased two-fold [ 191 ].…”

Overweight/obesity in adolescents with type 1 diabetes belonging to an admixed population. A Brazilian multicenter study

“…The presence of MS or insulin resistance are considered as risk factors for the presence of poor glycemic control, CKD and cardiovascular diseases (CVD) [ 7 ] and retinopathy [ 9 ]. Recently, MS was also associated with the presence non-alcoholic fatty liver disease (NAFDL) in patients with T1D as has recently been demonstrated in a study carried out in a tertiary care center in our country [ 8 ]. In this study, patients with altered hepatic images on ultrasound or transient elastography had higher body mass index (BMI) and presence of MS [ 8 ].…”

“…Recently, MS was also associated with the presence non-alcoholic fatty liver disease (NAFDL) in patients with T1D as has recently been demonstrated in a study carried out in a tertiary care center in our country [ 8 ]. In this study, patients with altered hepatic images on ultrasound or transient elastography had higher body mass index (BMI) and presence of MS [ 8 ].…”

Hepatopathy Associated With Type 1 Diabetes: Distinguishing Non-alcoholic Fatty Liver Disease From Glycogenic Hepatopathy

“…It is indeed important to highlight the lack of prospective studies and the intrinsic risk of referral/selection bias in the ultrasound and biopsy-based studies since most studies originate from tertiary care centers and rely on retrospective analysis of those patients that had either imaging or biopsy. To strengthen this hypothesis, a very recent cross-sectional study, not included in the aforementioned meta-analysis, recruited 103 participants without any selection criteria besides T1D, excessive ethyl consumption, or the absence of secondary liver diseases to evaluate NAFLD prevalence ( Barros et al, 2021 ). This study reported that the prevalence of steatosis was 12.6% based on classical ultrasound and 16.8% based on controlled attenuation parameter (CAP), a novel ultrasound-based marker of steatosis available on the Fibroscan © device (Echosens, Paris, France).…”