Presence of diabetes mellitus and steatosis is associated with liver stiffness in a general population: The Rotterdam study

Abstract

Given that little is known about the prevalence of, and factors associated with, liver fibrosis in the general population, we aimed to investigate this in a large, well-characterized cohort by means of transient elastography (TE). This study was part of the Rotterdam Study, a population-based study among individuals 45 years. All participants underwent abdominal ultrasound and TE. Liver stiffness measurement (LSM) 8.0 kilopascals (kPa) was used as a cutoff suggesting clinically relevant fibrosis. Of 3,041 participants (age, 66.0 6 7.6 years) with reliable LSM, 169 (5.6%) participants had LSM 8.0 kPa. Age (odds ratio [OR]: 2.40; 95% confidence interval [CI]: 1.72-3.36; P < 0.001), alanine aminotransferase (ALT; OR, 1.24; 95% CI: 1.12-1.38; P < 0.001), smoking (OR, 1.77; 95% CI: 1.16-2.70; P 5 0.008), spleen size (OR, 1.23; 95% CI: 1.09-1.40; P 5 0.001), hepatitis B surface antigen, or antihepatitis C virus positivity (OR, 5.38; 95% CI: 1.60-18.0; P 5 0.006), and combined presence of diabetes mellitus (DM) and steatosis (OR, 5.20; 95% CI: 3.01-8.98; P < 0.001 for combined presence) were associated with LSM 8.0 kPa in multivariable analyses. The adjusted predicted probability of LSM 8.0 kPa increased per age decade, with probabilities ranging from 1.4% (0.9-3.6) in participants ages 50-60 years to 9.9% (6.8-14.5) in participants >80 years. Participants with both DM and steatosis had the highest probabilities of LSM 8.0 kPa (overall probability: 17.2% [12.5-23.4]; this probability did not increase with age [P 5 0.8]). Conclusion: In this large population-based study of older adults, LSM 8.0 kPa, suggestive of clinically relevant fibrosis, was present in 5.6% and was strongly associated with steatosis and DM. In the context of an aging population and an increased prevalence of DM and obesity, this study illustrates that liver fibrosis may become a more prominent public health issue in the near future. (HEPATOLOGY 2016;63:138-147)

Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention

“…A community based study from the Netherlands using a transient elastography reading of ≥8 kPa for the diagnosis of liver fibrosis estimated that clinically significant fibrosis was present in 5.6% (169 of 3,041) of total, nonselected individuals and 8.4% (69 of 822) of those with NAFLD, and was positively associated with steatosis and T2DM 37 . In this respect, the influence of T2DM on risk of progressive NAFLD is sup ported by a UK based paired biopsy study that showed incident T2DM to be the strongest predictor of progres sive disease 38 .…”

The Role of Nuclear Receptors in the Pathophysiology, Natural Course, and Drug Treatment of NAFLD in Humans

“…[160][161][162]. In particular, the Rotterdam study conducted with transient elastography in 3041 participants found that the combined presence of T2D and steatosis was strongly associated with liver stiffness (8.0 kPa), suggestive of clinically relevant fibrosis [161].…”

Pancreatic Diabetes Mellitus and Heavy Drinking are Risk Factors for the Development of Liver Fibrosis in Alcoholic Chronic Pancreatitis

“…These results may suggest that the toxic injury was more severe and prolonged and the severity of ACP was more advanced in the ACP patients with liver fibrosis group [32,33]. Moreover, DM may induce steatohepatitis, which may act synergistic ally with alcohol to result in the liver parenchyma alterations and the TE findings [34,35]. DM was more frequent in our ACP patients than in a previous study [6] and this may explain the higher rate of ALF in our study as compared to the previous results.…”