Clinical and Biochemical Predictors of Nonalcoholic Fatty Liver Disease among Type 2 Diabetes Mellitus Patients at Primary Health Care Level in South Western Saudi Arabia

Abstract

Objectives: To predict the role of different clinical and biochemical parameters in identifying nonalcoholic fatty liver disease (NAFLD) among patients with type 2 diabetes mellitus (T2DM) in Abha city, southwestern Saudi Arabia. Methods: A stratified random sample was selected. A detailed clinical and biochemical examinations were performed. Using portable abdominal ultrasound examination, NAFLD was identified. The study used receiver operating characteristic (ROC) analysis. Results: The study covered 237 T2DM patients. NAFLD was detected among 174 patients. Area under the curve (AUC) calculations showed that the ability of age, duration of DM in years, and body mass index to predict NAFLD was poor (AUC < 0.6). Similarly, biochemical factors like HbA1c%, AST, cholesterol, triglycerides, HDL, LDL, and VLDL were poor in discriminating between those with and without NAFLD among T2DM. On the other hand, the ability of ALT to predict NAFLD among T2DM was good (AUC = 0.701, 95% CI: 0.637–0.761). The analysis identified the optimal cutoff point of ALT to be ≤22.1 nmol/L. The corresponding sensitivity was 60.7% (95% CI: 53.0–68.0) and specificity was 62.5% (95% CI: 49.5–74.3). Conclusions: Early identification of NAFLD among T2DM is important. A threshold cutoff value of 22.1 nmol/L of ALT has been identified to predict NAFLD. They should be referred for ultrasound examination for NAFLD.

Potential relation between non-alcoholic fatty liver disease and glycemic and metabolic parameters in subjects without diabetes

“…Similar observations were also obtained by a study among Montenegrin population, found that ALT was independent predictor for NAFLD but with a higher cutoff point of 22 IU/L [24]. These results are also consistent with that of Al Humayed et al [25] who identified that ALT is a predictor for NAFLD with a threshold cutoff value of 22.1 nmol/L. Our lower ALT cutoff point might be explained by that the present study was done among individuals without diabetes while the participants of other studies had diabetes.…”

A Novel Identified Peptide Hormone “Metabolitin” Attenuates Lipid Absorption in the Small Intestine of Diabetic Mice with Nonalcoholic Fatty Liver Disease by Regulating Neurotensin and AMPK Signaling Pathway

“…In clinical, NAFLD patients are more likely to suffer from metabolic syndrome, such as obesity, insulin resistance, type 2 diabetes mellitus (T2DM), dyslipidemia, and hypertension [ 5 , 6 ]. Among these complications, T2DM seems to be the essential clinical predictor of adverse clinical reactions, such as advanced liver fibrosis and mortality in NAFLD patients [ 7 , 8 ]. A systematic review and meta-analysis reported that, among T2DM patients, the global prevalence of NAFLD and NASH was 55.5% and 37.3%, respectively, and about 17.0% advanced fibrosis in patients with NAFLD and T2DM [ 9 ].…”