Determination of Frequency of Diabetes and Pre-Diabetes in Patients with Nonalcoholic Fatty Liver Disease and Comparison with a Control Group

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in Western industrialized countries. The pathogenesis of NAFLD has not been clearly determined, but the most widely supported theory is the mechanism of insulin resistance. Therefore, the aim of this study was to evaluate the frequency of diabetes and pre-diabetes in patients with NAFLD.Methods: The present study was performed on 80 patients and 26 healthy controls matched for age and sex. Patients were diagnosed with NAFLD through ultrasound and were selected. From each participant, a 5 cc sample of blood was obtained and sent to a pathology laboratory for analysis. Quantitative data and qualitative data were analyzed using t-test and chi-square test, respectively. Moreover, multivariate tests, such as regression tests, were used where necessary.Findings: Among the participants, 64 (60.3%) were women and 42 (39.7%) were men. The average age of the subjects in the case group was 48.8 ± 10.8 years and in the control group was 42.3 ± 13.4 years. Of the 106 participants, 44 patients (41.5%) had pre-diabetes and 11 (10.4%) had diabetes; all were in the case group. In the control group, no subjects had pre-diabetes (P < 0.001) or diabetes (P = 0.046). After removing age as a confounder, the only variables that differed significantly between the two groups and were higher in the case group were hemoglobin A1c (HbA1c), fasting plasma glucose, insulin, cholesterol, aspartate transaminase (AST), alanine transaminase (ALT), two-hour blood glucose. Moreover, with the removal of BMI as a confounder, only hemoglobin A1C, fasting blood glucose, insulin, and ALT showed significant differences between the two groups.Conclusion: This study showed that the prevalence of diabetes in patients with NAFLD was high. Even with the removal of confounding factors, factors associated with diabetes, such as hemoglobin A1c, fasting plasma glucose, and insulin, had significant association with this disease, indicating a strong relationship between the two diseases.

Keywords

References

  1. Younossi ZM, Gramlich T, Matteoni CA, Boparai N, McCullough AJ. Nonalcoholic fatty liver disease in patients with type 2 diabetes. Clin Gastroenterol Hepatol 2004; 2(3): 262-5.
  2. Chitturi S, Farrell GC, Hashimoto E, Saibara T, Lau GK, Sollano JD. Non-alcoholic fatty liver disease in the Asia-Pacific region: definitions and overview of proposed guidelines. J Gastroenterol Hepatol 2007; 22(6): 778-87.
  3. Amarapurkar DN, Hashimoto E, Lesmana LA, Sollano JD, Chen PJ, Goh KL. How common is non-alcoholic fatty liver disease in the Asia-Pacific region and are there local differences? J Gastroenterol Hepatol 2007; 22(6): 788-93.
  4. Sheth SG, Gordon FD, Chopra S. Nonalcoholic steatohepatitis. Ann Intern Med 1997; 126(2): 137-45.
  5. Bacon BR, Farahvash MJ, Janney CG, Neuschwander-Tetri BA. Nonalcoholic steatohepatitis: an expanded clinical entity. Gastroenterology 1994; 107(4): 1103-9.
  6. Mulhall BP, Ong JP, Younossi ZM. Non-alcoholic fatty liver disease: an overview. J Gastroenterol Hepatol 2002; 17(11): 1136-43.
  7. Younossi ZM, Diehl AM, Ong JP. Nonalcoholic fatty liver disease: an agenda for clinical research. Hepatology 2002; 35(4): 746-52.
  8. Islam MR, Arslan I, Attia J, McEvoy M, McElduff P, Basher A, et al. Is serum zinc level associated with prediabetes and diabetes?: a cross-sectional study from Bangladesh. PLoS One 2013; 8(4): e61776.
  9. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27(5): 1047-53.
  10. Beletate V, El Dib RP, Atallah AN. Zinc supplementation for the prevention of type 2 diabetes mellitus. Cochrane Database Syst Rev 2007; (1): CD005525.
  11. Diagnosis and classification of diabetes mellitus. Diabetes Care 2011; 34(Suppl 1): S62-S69.
  12. Atkinson MA, Maclaren NK. The Pathogenesis of Insulin-Dependent Diabetes Mellitus. N Engl J Med 1994; 331(21): 1428-36.
  13. Merat S, Yarahmadi S, Tahaghoghi S, Alizadeh Z, Sedighi N, Mansournia N, et al. Prevalence of fatty liver disease among type 2 diabetes mellitus patients and its relation to insulin resistance. Middle East J Dig Dis 2009; 1(2): 74-9.
  14. Ortiz-Lopez C, Lomonaco R, Orsak B, Finch J, Chang Z, Kochunov VG, et al. Prevalence of prediabetes and diabetes and metabolic profile of patients with nonalcoholic fatty liver disease (NAFLD). Diabetes Care 2012; 35(4): 873-8.
  15. Willner IR, Waters B, Patil SR, Reuben A, Morelli J, Riely CA. Ninety patients with nonalcoholic steatohepatitis: insulin resistance, familial tendency, and severity of disease. Am J Gastroenterol 2001; 96(10): 2957-61.
  16. Musso G, Cassader M, Rosina F, Gambino R. Impact of current treatments on liver disease, glucose metabolism and cardiovascular risk in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of randomised trials. Diabetologia 2012; 55(4): 885-904.
  17. Hossein Panah F, Sadeghi L, Rambod M, Foroutan M, Naseri M. Assessing predicting factors in non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes. Pajouhesh Dar Pezeshki 2006; 30(10): 9-15. [In Persian].
  18. Day CP, James OF. Steatohepatitis: a tale of two "hits"? Gastroenterology 1998; 114(4): 842-5.
  19. Sanyal AJ. Mechanisms of Disease: pathogenesis of nonalcoholic fatty liver disease. Nat Clin Pract Gastroenterol Hepatol 2005; 2(1): 46-53.
  20. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999; 116(6): 1413-9.
  21. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002; 346(16): 1221-31.
  22. Osawa H, Mori Y. Sonographic diagnosis of fatty liver using a histogram echnique that compares liver and renal cortical echo amplitudes. J Clin Ultrasound 1996; 24(1): 25-9.
  23. Saverymuttu SH, Joseph AE, Maxwell JD. Ultrasound scanning in the detection of hepatic fibrosis and steatosis. Br Med J (Clin Res Ed) 1986; 292(6512): 13-5.
Journal of Isfahan Medical School
Volume 33, Issue 368 - Serial Number 368
November and December 2016
Pages 2440-2447

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History

  • Receive Date: 14 October 2015
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

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