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Screening of Diabetic Patients for Non-Alcoholic Fatty Liver Disease Based on Liver Indices: A Retrospective Cross-Sectional Study


Affiliations
1 Senior Research Fellow, Kasturba Health Society Medical Research Centre (KHS-MRC), India
2 Physician, KHS-MRC, India
3 Director-Integrative Medicine and Clinical Research, KHS-MRC, India
4 Director-Division of Endocrinology, KHS-MRC, India
     

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Background and Aims: Non-Alcoholic Fatty Liver Disease (NAFLD) includes a wide spectrum of liver pathophysiology, ranging between relatively benign Nonalcoholic fatty liver to a serious pathology like fibrosis and cirrhosis. NAFLD is commonly associated with Type 2 Diabetes Mellitus (T2DM) and Metabolic Syndrome and may increase the risk for mortality. American Diabetes Association and European Association for the study of Diabetes have recommended screening of all T2DM patients for NAFLD.

Materials and Methods: We did a retrospective analysis of medical records of T2DM patients who attended a diabetes clinic as ambulant patients for 1 year. Out of 215 patients, complete demographic, haemodynamic and biochemical data was available for 46 patients. Simple liver indices like Hepatic Steatosis Index (HSI) and Fibrosis score (FIB-4) were computed.

Results: Presence of steatosis was observed in30 patients based on HSI > 36. Out of these, intermediate risk of advanced fibrosis was observed in 4 patients based on FIB-4 > 1.3.

Conclusion: HSI based screening for steatosis and FIB-4 based screening for fibrosis should be part of liver monitoring in patients with type 2 diabetes mellitus to identify individuals with higher risk for NAFLD.


Keywords

Hepatic Steatosis Index, Fibrosis Score, Non-Alcoholic Fatty Liver Disease, Nonalcoholic Steatohepatitis.
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  • Pradeepa R, Mohan V. Epidemiology of type 2 diabetes in India. Indian J. Ophthalmol 2021; 69:2932-8.

  • Mitra S. Diabetes Research, Prevalence, and Intervention in India. European Journal of Environment and Public Health 2019, 3(1), 1-5. Available at, http://dx.doi.org/10.20897/ejeph/4004

  • Dharmalingam M and Yamasandhi PG. Nonalcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus.Indian J Endocrinol Metab. 2018; 22(3): 421-428.doi: 10.4103/ijem.IJEM_585_17, PMCID: PMC6063173PMID: 30090738

  • Weiti Wu, Jingjing Xiang, Xiaoye Chen, Association Between Diabetes Mellitus and All-Cause and Cardiovascular Mortality Among Individuals with Ultrasound-Defined Non-Alcoholic Fatty Liver Disease. 2021; 12:773342, doi: 10.3389/fendo.2021.773342, PMID: 34992579, PMCID: PMC8724262

  • De A, Duseja A, Nonalcoholic Fatty Liver Disease: Indian Perspective. Clinical Liver Disease September 2021; 18 (3): 158-163.

  • Sumida Y, Nakajima A, Hyogo H, Tanaka S, Ono M, Fujii H, et al. Non-invasive scoring systems for predicting NASH in Japan: evidence from Japan Study Group of NAFLD. Integr Mol Med 2015: 2(2): 145-149. doi: 10.15761/IMM.1000130

  • Dhamija, E, Paul, SB, Kedia, S. Non-alcoholic fatty liver disease associated with hepatocellular carcinoma: An increasing concern. The Indian journal of medical research 2019; 149(1): 9-17. https://doi.org/10.4103/ijmr.IJMR_1456_17

  • Viswanathan V, Kadiri M, Medimpudi S, Kumpatla S, Association of non-alcoholic fatty liver disease with diabetic microvascular and macrovascular complications in south Indian diabetic patients. International Journal of Diabetes in Developing countries. 2010; 30(4): 208-212.

  • Barbosa JV, Lai M. Nonalcoholic Fatty Liver Disease Screening in Type 2 Diabetes Mellitus Patients in the Primary Care Setting. Hepatology Communications 2021; 5(2):158-167. https://doi.org/10.1002/hep4.1618

  • Adams LA, Lymp JF, St Sauver J, et al. The natural history of non alcoholicfatty liver disease: a population-based cohort study. Gastroenterology2005; 129:113-21.

  • Arslan U, Turkoglu S, Balcioglu S, et al. Association between nonalcoholic fatty liver disease and coronary artery disease. Coron Artery Dis 2007; 18:433-6.

  • Lee JH, Kim D, Kim HJ, Lee CH, Yang JI, KimW,et al. Hepatic Steatosis Index: A simple screening tool reflectingnonalcoholic fatty liver disease. Digestive and Liver Disease 2010; 42(7): 503-508.doi: 10.1016/j.dld.2009.08.002

  • Fennoun H, Mansouri SE, Tahiri M, Haraj NE, Aziz SE, Hadad F, et al. Interest of hepatic steatosis index (HSI) in screening for metabolic steatopathy in patients with type 2 diabetes. Pan Afr Med J. 2020; 37: 270.doi: 10.11604/pamj.2020.37.270.9087, PMCID: PMC7864273, PMID: 33598084

  • Lomonaco R, LeivaEG,Bril F, Shrestha S, MansourL,Budd J et al. Advanced Liver Fibrosis IsCommon in Patients with Type 2 Diabetes Followed in the Outpatient Setting: The Need for Systematic Screening. Diabetes Care 2021; 44:399-406 | https://doi.org/10.2337/dc20-1997

  • Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V, et al. ‘FIB-4: an Inexpensive and Accurate Marker of Fibrosis in HCV Infection. Comparison with Liver Biopsy and FibroTest. Hepatology 2007; 46 (1): 32-36.

  • Rinella ME. Nonalcoholic fatty liver disease: Asystematic Review. JAMA, 2015; 313: 2263-73.

  • Nanji AA, French SW, Freeman JB. Serum alanine amino transferase to aspartate amino transferase ratio and degree of fatty liver in morbidly obese patients. Enzyme 1986; 36: 266-9.

  • Long MT, Pedley A, Colantonio LD, Massaro JM, Hoffmann U, Muntner P et al. Development and validation of the Framingham Steatosis index to identify persons with hepatic steatosis. Clin Gastroenterol Hepatol, 2016; 14: 1072-1180.

  • Ken Liu K, Xu W, Vincent Wai-Sun Wong. Serum biomarkers for nonalcoholic fatty liver disease: Are we there yet? Hepatology. 2017; 65(1): 8-11. doi: 10.1002/hep.28840. PMID: 27639247 DOI: 10.1002/hep.28840

  • Sberna AL, B. Bouillet B, Rouland A, Brindisi MC, Nguyen A, Mouillot T, Duvillard L, Denimal D, Loffroy R, Verges B, Hillon P, Petit M. European Association for the Study of the Liver (EASL),European Association for the Study of Diabetes (EASD),and European Association for the Study of Obesity (EASO), clinical practice recommendations for the managementof non-alcoholic fatty liver disease: evaluation of their application in peoplewithType2diabetes.https://www.researchgate.net/profile/Jean-Michel-Petit/publication/321862648_ Diabet. Med. 00: 000–000 (2018)

  • Shah AG, LydeckerA, Murray K, Tetri BN, ContosMJ, Sanyal AJ, and NASH Clinical Research Networket. Use of the fib4 index for non-invasive evaluation of fibrosis in nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009 October; 7(10): 1104–1112. doi: 10.1016/j.cgh.2009.05.033.


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  • Screening of Diabetic Patients for Non-Alcoholic Fatty Liver Disease Based on Liver Indices: A Retrospective Cross-Sectional Study

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Authors

Anand Shindikar
Senior Research Fellow, Kasturba Health Society Medical Research Centre (KHS-MRC), India
Anushree Mehta
Physician, KHS-MRC, India
Ashwinikumar Raut
Director-Integrative Medicine and Clinical Research, KHS-MRC, India
Rama Vaidya
Director-Division of Endocrinology, KHS-MRC, India

Abstract


Background and Aims: Non-Alcoholic Fatty Liver Disease (NAFLD) includes a wide spectrum of liver pathophysiology, ranging between relatively benign Nonalcoholic fatty liver to a serious pathology like fibrosis and cirrhosis. NAFLD is commonly associated with Type 2 Diabetes Mellitus (T2DM) and Metabolic Syndrome and may increase the risk for mortality. American Diabetes Association and European Association for the study of Diabetes have recommended screening of all T2DM patients for NAFLD.

Materials and Methods: We did a retrospective analysis of medical records of T2DM patients who attended a diabetes clinic as ambulant patients for 1 year. Out of 215 patients, complete demographic, haemodynamic and biochemical data was available for 46 patients. Simple liver indices like Hepatic Steatosis Index (HSI) and Fibrosis score (FIB-4) were computed.

Results: Presence of steatosis was observed in30 patients based on HSI > 36. Out of these, intermediate risk of advanced fibrosis was observed in 4 patients based on FIB-4 > 1.3.

Conclusion: HSI based screening for steatosis and FIB-4 based screening for fibrosis should be part of liver monitoring in patients with type 2 diabetes mellitus to identify individuals with higher risk for NAFLD.


Keywords


Hepatic Steatosis Index, Fibrosis Score, Non-Alcoholic Fatty Liver Disease, Nonalcoholic Steatohepatitis.

References