Prevalence and Specific Manifestations of Non-alcoholic Fatty Liver Disease (NAFLD) and Diabetes Mellitus Type 2 Association in a Moroccan Population: A Cross-sectional Study

Abstract

OBJECTIVE: Non-alcoholic fatty liver disease (NAFLD) is recognized as a common cause of chronic liver disease worldwide. Its association with type 2 diabetes mellitus (T2DM) is known to increase the risk of degenerative complications of diabetes and the likelihood of developing severe hepatic injuries. The objective of this study was to assess the prevalence of NAFLD and to describe the characteristics of its association with T2DM. METHODS: This was a descriptive analytical study, involving patients with T2DM with no history of alcohol consumption, viral hepatitis, hepatotoxic medications, or other chronic liver diseases. The patients underwent an investigation of NAFLD including abdominal ultrasound, non-invasive biomarkers of liver fibrosis, elastography and ultrasound-guided liver biopsy. RESULTS: We collected data from 180 patients with a mean age of 59.3 ± 10.9 years with strong female predominance. The mean duration of diabetes progression was 9.2 ± 7.3 years. Hepatic sonography showed signs of NAFLD in 45.6% of cases. Non-invasive hepatic biomarkers indicated significant fibrosis in 18.3% of cases. Overall, 21% of patients underwent an elastography evaluation, revealing severe fibrosis or cirrhosis in 15.4% of patients. The diagnosis of NASH (Non-alcoholic steatohepatitis) was confirmed histologically in 3 patients. The overall prevalence of NAFLD was 45.6%. Patients with NAFLD had a statistically significant incidence of obesity, metabolic syndrome, hypertension, dyslipidemia, macrovascular complications, and hypertriglyceridemia (p < 0.05). CONCLUSIONS: The combination of NAFLD and T2DM is often found in patients with obesity or metabolic syndrome. The presence of NAFLD can be responsible for increased morbidity and important cardiovascular risks in patients with T2DM.

High Prevalence of Severe Hepatic Fibrosis in Type 2 Diabetic Outpatients Screened for Non-Alcoholic Fatty Liver Disease

“…Moreover, a serious warning came from our study since 23.9% of screened T2D patients had clinically meaningful liver harm, with a FIB-4 score > 2 and/or stiffness > 10.1 kPa. Similar results have been shown in a small study conducted in Morocco [37], where noninvasive hepatic biomarkers indicated the presence of significant fibrosis in 18.3% of the studied population.…”

Prevalence of metabolic dysfunction-associated fatty liver disease and its association with glycemic control in persons with type 2 diabetes in Africa: a systematic review and meta-analysis

“…This review consisted of nine cross-sectional and one case control studies published between 2011 and 2023. The studies were conducted in 6 different Africa countries, with majority coming from Nigeria (n=3) [24–26], followed by Ethiopia (n=2) [27, 28], Morocco (n=2) [29, 30], and one each from Egypt [31], Ghana [32], and Sudan [33]. A total of 1667 T2D participants were involved, with the sample size ranging from 80 to 281 across studies.…”

“…The quality score across studies ranged from 8 to 3, with a mean score of 6.1. Majority (n=6) of the studies were of low risk of bias, having a score above 7 [25–28, 30, 32]. In contrast, four studies fell below a cut-off score of 5, indicating a higher risk of bias [24, 29, 31, 33].…”

Prevalence of metabolic dysfunction-associated fatty liver disease and its association with glycemic control in persons with type 2 diabetes in Africa: A systematic review and meta-analysis

“…The quality score across studies ranged from 8 to 3, with a mean score of 6.1. Majority (n = 6) of the studies were of low risk of bias, having a score above 7 [ 29 – 32 , 34 , 36 ]. In contrast, four studies fell below a cut-off score of 5, indicating a higher risk of bias [ 28 , 33 , 35 , 37 ].…”