Details
Category: Volume 07 Issue 11 November 2019
Hits: 1090

Title: Non-Alcoholic fatty liver disease and Diabetes Mellitus

Authors: Dr Tameem Imran, Dr Rumaisa Ahmed, Dr Vishwanath Reddy

 DOI: https://dx.doi.org/10.18535/jmscr/v7i11.137

Abstract

Diabetes is a systemic disease that affects almost all organ systems. Apart from causing major macro & microvascular complications Non-alcoholic fatty liver disease (NAFLD) is being increasingly recognized today as a potentially serious complication of diabetes, especially type 2.

The high incidence of non-alcoholic steatohepatitis (NASH) in patients with T2DM leads to further complications, such as liver cirrhosis and hepatocellular carcinoma, which are increasingly recognized.[4]

So it is of prime importance to screen for Non-alcoholic fatty liver disease (NAFLD) before it progresses to NASH.

This observational study was conducted at R L Jalappa Hospital on 75 diabetics (both type 1 and type 2).

Among the 75 diabetics who were studied, fatty liver was found in 32 patients (42.66%). All the patients with fatty liver had central obesity. Overweight among the persons detected to have fatty liver – 25 (78.1%).

NASH can exist with only nonspecific symptoms for years in obese patients before manifesting itself either incidentally or with complications of cirrhosis or portal hypertension.

NAFLD and NASH have been described in patients without the classic risk factors of obesity, diabetes, and overt hyperlipidemia. Hypertriglyceridemia was identified as an important risk factor in the development of NAFLD and NASH.

Conclusion: The prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus was 42.6%. It occurred more commonly in women (65.6%) than men.

References

  1. WHO: Projections of global mortality and burden of disease from 2002 to 2030. Mathers CD, Loncar D. PLoS Med, 2006, 3(11):e442.
  2. Members [Internet].Idf.org. 2018 [cited 22 October 2018]. Available from: https://www.idf.org/our-network/regions-members/south-east-asia/members/94-india
  3. European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO clinical practice guidelines for the management of the non-alcoholic fatty liver disease. J Hepatol 2016;64:1388-402.
  4. Tilg H, Moschen A, Roden M. NAFLD and diabetes mellitus. Nature Reviews Gastroenterology &Hepatology. 2016;14(1):32-42.
  5. Hillenbrand A, Kiebler B, Schwab C, Scheja L, Xu P, Henne-Bruns D, et al. Prevalence of non-alcoholic fatty liver disease in four different weight-related patient groups: Association with small bowel length and risk factors. BMC Res Notes 2015;8:290.
  6. Ryu S, Chang Y, Jung HS, Yun KE, Kwon MJ, Choi Y, et al. Relationship of sitting time and physical activity with the non-alcoholic fatty liver disease. J Hepatol 2015;63:1229-37.
  7. Anstee QM, McPherson S, Day CP. How big a problem is the non-alcoholic fatty liver disease? BMJ 2011;343:d3897.
  8. Singh S, Allen AM, Wang Z, Prokop LJ, Murad MH, Loomba R, et al. Fibrosis progression in nonalcoholic fatty liver vs. nonalcoholic steatohepatitis: A systematic review and meta-analysis of paired-biopsy studies. Clin Gastroenterol Hepatol 2015; 13:643-540.
  9. Hazlehurst JM, Woods C, Marjot T, Cobbold JF, Tomlinson JW. Non-alcoholic fatty liver disease and diabetes. Metabolism 2016;65:1096-108.
  10. Daad H. Akbar, Abeer H. Kawther. Diabetes Care 26:3351-3352, 2003.
  11. Wanless IR, Lentz JS. Fatty liver hepatitis (steatohepatitis) and obesity: An autopsy study with analysis of risk factors. Hepatology 1990;12: 1106 -1110.
  12. Garcia Monzon C, Martin Perez E, Lo Iacono O et al. Characterization of pathogenic and prognostic factors of nonalcoholic steatohepatitis associated with obesity. J Hepatol 2000;33:716-724.
  13. Gupta P, Amarapukar D, Agal S, et al. Non-alcoholic steatohepatitis in type 2 diabetes mellitus. J Gastroenterol Hepatol. 2004 Aug;19(8):854-8.
  14. Stephen H Caldwell, Tri H Le, Stacey M Anderson. Schiff’s diseases of the Liver, 9th ed, edited by Eugene Schiff, Michael F Sorrell, Willis C Maddrey. Lippincott Williams and Wilkins pub, 2003. 1261 – 1280.
  15. Assy N, Kaita K, Mymin D et al. Fatty infiltration of liver in hyperlipidemic patients. Dig Dis Sci 2000;45:1929-1934.
  16. Dai W, Ye L, Liu A, Wen S, Deng J, Wu X et al. Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus. Medicine. 2017;96 (39) :e8179.
  17. Wilner IR, Waters B, Patil SR et al. Ninety patients with alcoholic steatohepatitis: Insulin resistance, familial tendencies, and severity. Am J Gastroenterol 2017;96: 2957-2961.
  18. Day CP, James OFW. Steatohepatitis: a tale of two hits. Gastroenterology 2016;114:842-845.
  19. Sayiner M, Koenig A, Henry L, Younossi ZM. Epidemiology of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis in the United States and the Rest of the World. Clin Liver Dis. 2016;20:205–214.

Corresponding Author

Dr Tameem Imran