A Study of Prevalence of Diabetes and Prediabetes in Patients of Non-Alcoholic Fatty Liver Disease and the Impact of Diabetes on Liver Histology in Coastal Eastern India

Abstract

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is more common in diabetic patients. There are limited studies on clinical, biochemical and histological features of NAFLD patients who are diabetic. The aim of the study was to determine the prevalence of diabetes and prediabetes in a cohort of NAFLD patients and to compare anthropometry, biochemical and metabolic parameters and hepatic histology of diabetic NAFLD patients with non-diabetic NAFLD patients. Methods: 515 consecutive NAFLD patients diagnosed by abdominal ultrasound and 100 healthy controls were subjected to detailed anthropometric measurements and biochemical assays including blood sugars, LFT, lipid profile and HOMA. Diabetes and prediabetes were defined according to WHO criteria. Patients were categorized and compared according to the presence or absence of diabetes. Liver biopsy was performed in 240 NAFLD patients and the liver histology was also compared between the two groups. Statistical analysis was performed on SPSS 16. Results: 124 out of the 515 (24.08%) NAFLD patients were diabetics, 118 out of 515 (22.9%) were pre-dia-* Corresponding author. S. P. Singh et al. 291 betics, while only 3 out of 100 controls had impaired glucose tolerance. Diabetic patients were older. NAFLD patients with diabetes had significantly higher waist circumference [98.02 ± 12.01 vs 93.89 ± 8.8, p = 0.000] as compared to the NAFLD patients without diabetes. Fasting blood sugar [124 ± 46.3 vs 90.8 ± 10.2, p = 0.000], triglyceride level [218.4 ± 17.6 vs 192 ± 9, p = 0.03] and HOMA-IR [2.6 ± 0.36 vs 1.84 ± 0.2, p < 0.001] were significantly higher in NAFLD-diabetes group. Hypertension [35% vs 11.7%, p = 0.000] was commoner in diabetic NAFLD patients. Histopathology in the diabetic patients revealed steatosis alone in 34.2% cases, borderline NASH in 31.4% and definite NASH in 34.2%. Fatty change alone was noted in 16.5% cases, borderline NASH in 34.1%, while 49% had definite NASH on liver biopsy of NAFLD patients without diabetes. Fibrosis was noted in 31.4% in diabetic and 27% in non-diabetic patients. IR alone had a linear correlation with necroinflammatory activity. Conclusion: The prevalence of diabetes and prediabetes is six times more in NAFLD patients than in healthy controls. NAFLD patients with diabetes have higher metabolic risk factors such as large waistline, hypertension, high triglyceride levels and increased insulin resistance. Diabetes or pre diabetes patients per se do not have histologically severe disease, rather insulin resistance play an important role in increasing the severity of the disease.

Evaluation of the Efficacy of Dawa-Ul-Kurkum in Su-E-Mizaj Kabid Barid (Non-Alcoholic Fatty Liver Disease): A Randomized Single Blind Placebo Controlled Study

“…Majority of the patients (45%) were overweight, 42.5% had Grade I obesity, while only 12.5% were normal weight subjects in the study. The outcome well-matched with the studies of Duseja A and Singh SP et al where in the highest prevalence is seen among patients with BMI > 25 10,19 . This study is consistent with Amarapurkar D et al, Alam S et al, Singh SP et al, Somalwar AM et al and Hu X et al 13,14,23,24,25 Effect on Subjective Parameters Anorexia: In this study assessing anorexia before and after the treatment at various assessment days, it was found that, 7(35%) patients had mild anorexia, 1(5%) patient had moderate anorexia, 12 (60%) patients had no anorexia at baseline in group-A while 9 (45%) patients had mild anorexia, 1 (5%) patient had moderate anorexia, and 10 (50%) patients had no anorexia at baseline in group-B.…”

“…The baseline demographic data has been given in Table no [10][11][12][13][14] A majority of trial subjects (52.5%) registered were males and 47.5% were females, which supports the results stated by Singh et al and Ajay Duseja that non-alcoholic fatty liver is more common in males than females 1,15 . The gender differences in NAFLD and NASH can be probably explained by gender disparities in body fat distribution, lifestyle, and sex hormone metabolism 16 .…”

“…The difference was statistically insignificant in both the groups in pre and post comparison as well as in between the group comparison using paired and unpaired student t test respectively (Table no. 10). Laboratory values may be normal in up to 80% of persons with fatty liver according to Papadakis et al and Majumdar A et al 5,43 Similarly the assessment of Total Cholesterol TGS, LDL and HDL was done in both the groups at baseline and after the treatment.…”

Is NAFLD a Risk Factor for Colorectal Polyps? An Analysis of Single Romanian Centre

“…Currently, non-alcoholic fatty liver disease (NAFLD) is considered to be an integral part of the metabolic syndrome with insulin resistance as a central pathogenic factor. It is considered nowadays that NAFLD may represent a risk factor for development of adenomatous polyps, however little is known about the possible association between colorectal neoplasms and NAFLD [6][7][8].…”

Nonalcoholic Fatty Liver Disease Alone Is a Better Predictor of Metabolic Syndrome and Insulin Resistance than Existing ATP-III Criteria

“…A study from coastal eastern India has shown that both in NAFLD patients, insulin resistance was closely associated not only with fatty liver but also histologically severe disease [28]. Thus, NAFLD might represent another feature of the metabolic syndrome, with decreased insulin sensitivity being the common factor [29].…”