Non-alcoholic fatty liver disease and incidence of microvascular complications of diabetes in patients with type 2 diabetes: a prospective cohort study

Abstract

ObjectiveTo investigate the association between non-alcoholic fatty liver disease (NAFLD) and liver enzymes with the incidence of microvascular complications (neuropathy, retinopathy, and nephropathy) in a cohort of Iranian patients with type 2 diabetes.MethodsFor a total population of 3123 patients with type 2 diabetes, a prospective study was designed for 1215 patients with NAFLD and 1908 gender and age-matched control patients without NAFLD. The two groups were followed for a median duration of 5 years for the incidence of microvascular complications. The association between having NAFLD, the level of liver enzymes, aspartate aminotransferase to platelet ratio index (APRI), Fibrosis-4 (FIB-4) value, and the incidence risk of diabetic retinopathy, neuropathy, and nephropathy were assessed through logistic regression analysis.ResultsNAFLD was found to be associated with incidence of diabetic neuropathy and nephropathy (Odds ratio: 1.338 (95% confidence interval: 1.091-1.640) and 1.333 (1.007-1.764), respectively). Alkaline-phosphatase enzyme was found to be associated with higher risks of diabetic neuropathy and nephropathy ((Risk estimate: 1.002 (95% CI: 1.001-1.003) and 1.002 (1.001-1.004), respectively)). Moreover, gamma-glutamyl transferase was associated with a higher risk of diabetic nephropathy (1.006 (1.002-1.009). Aspartate aminotransferase and alanine aminotransferase were inversely associated with the risk of diabetic retinopathy (0.989 (0.979-0.998) and 0.990 (0.983-0.996), respectively). Furthermore, ARPI_T (1), ARPI_T (2), and ARPI_T (3) were shown to be associated with NAFLD (1.440 (1.061-1.954), 1.589 (1.163-2.171), and 2.673 (1.925, 3.710), respectively). However, FIB-4 score was not significantly associated with risk of microvascular complications.ConclusionDespite the benign nature of NAFLD, patients with type 2 diabetes should be always assessed for NAFLD to ensure early diagnosis and entry into proper medical care. Regular screenings of microvascular complications of diabetes is also suggested for these patients.

TG: A Mediator of the Relationship of Serum Uric Acid to Creatinine Ratio and Nonalcoholic Fatty Liver Disease in Non-Obese Patients with Type 2 Diabetes

“…One prospective study reported that NAFLD increases the risk of diabetic retinopathy and diabetic nephropathy (OR = 1.338 (95% CI: 1.091-1.640) and 1.333 (1.007-1.764)). 7 However, previous studies have not explored the interference of obesity as a factor. As we all know obesity and overweight are both risk factors for NAFLD, and it is easier to distinguish NAFLD in the obese population; however, Asian T2DM patients tend to be normal weight or overweight, and fewer studies have been conducted on the identification of NAFLD in non-obese T2DM individuals.…”

“…5 Worryingly, patients with NAFLD combined with T2DM have a significantly higher incidence of diabetic microvascular diseases such as diabetic peripheral neuropathy or diabetic nephropathy. 7 Given the high incidence rate of NAFLD and the multiple adverse outcomes associated with it, the early discovery of NAFLD in T2DM patients is of particular importance.…”

Clinical Evidence of the Relationship Between Alanine Aminotransferase and Diabetic Kidney Disease

“…10 Conversely, when diabetes progresses to the DKD stage, its relationship with ALT has been less investigated, and the limited findings are controversial. [11][12][13] For example, one recent prospective study including 3123 diabetic patients with a median 5-year follow-up showed that ALT activity was not associated with DKD risk [odds ratio (OR)=1.001, 95% CI=0.994-1.009, P=0.769] after adjusting for potential confounders. 11 In contrast, another retrospective study including 690 diabetic patients with a mean follow-up of 6.2±4.4 years indicated that elevated ALT activity was associated with the remission of DKD (OR=1.01, 95% CI=1.002-1.018, P < 0.05).…”

“…[11][12][13] For example, one recent prospective study including 3123 diabetic patients with a median 5-year follow-up showed that ALT activity was not associated with DKD risk [odds ratio (OR)=1.001, 95% CI=0.994-1.009, P=0.769] after adjusting for potential confounders. 11 In contrast, another retrospective study including 690 diabetic patients with a mean follow-up of 6.2±4.4 years indicated that elevated ALT activity was associated with the remission of DKD (OR=1.01, 95% CI=1.002-1.018, P < 0.05). 12 In addition, none of the above studies focused on the dose-response relationship between ALT and DKD.…”