USA: A recent study published in the journal Obesity has suggested a link between diabetes and diabetes plus obesity to a higher risk of moderate to advanced fibrosis. The results showed that the majority of diabetes patients, even those in the early stages of obesity had steatosis and a high prevalence of fibrosis.
People with diabetes or obesity with increased alanine aminotransferase or steatosis are said to be at high risk for steatohepatitis with advanced liver fibrosis (nonalcoholic steatohepatitis fibrosis) and cirrhosis. However, the knowledge is derived largely from the selected population and has not yet been observed in a large cohort in the general population. The interaction and/or added risk of having both obesity and diabetes for fibrosis development remains unclear.
Against the above background, Kenneth Cusi, Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida, USA, and colleagues aimed to assess the impact of diabetes on nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) with advanced fibrosis prevalence in overweight/obese people in the United States.
The study included 834 middle-aged patients with DM (21.7%) and 3,007 without DM (78.3%) from the National Health and Nutrition Examination Survey [NHANES] 2015-2016 database. NAFLD was defined by Fatty Liver Index (FLI) ≥ 60 or United States FLI (USFLI) ≥ 30.
Moderate-to-high and high risk of advanced fibrosis were defined by fibrosis-4 index (FIB-4) ≥ 1.67 and ≥ 2.67, respectively, and NAFLD fibrosis scores > 0.676 also indicated high risk.
The study revealed the following findings:
NAFLD prevalence increased with BMI.
Steatosis was higher in individuals with overweight with diabetes mellitus (DM) versus without DM (USFLI ≥ 30: 48.3% vs. 17.4%) and in individuals with obesity with DM versus without DM (USFLI ≥ 30: 79.9% vs. 57.6%).
DM significantly increased the proportion of individuals at moderate-to-high risk of fibrosis (FIB-4 ≥ 1.67: 31.8% vs. 20.1%).
In the high risk of the advanced fibrosis group (FIB-4 ≥ 2.67), the risk almost doubled (3.8% vs. 7.1%).
Among individuals with obesity, DM increased the proportion of adults with a moderate and high risk of fibrosis by 1.8- and 2.5-fold, respectively.
"In the US cohort DM modestly impacted steatosis that was driven primarily by obesity," wrote the authors. "DM added a significant risk of fibrosis to individuals with overweight or obesity, suggesting that screening is imperative in adults with DM."
Reference:
The study titled, "Type 2 diabetes mellitus increases the risk of hepatic fibrosis in individuals with obesity and nonalcoholic fatty liver disease," was published in the journal Obesity.
DOI: https://doi.org/10.1002/oby.23263