Makker J, Tariq H, Kumar K, Ravi M, Shaikh DH, Leung V, Hayat U, Hassan MT, Patel H, Nayudu S, Chilimuri S. Prevalence of advanced liver fibrosis and steatosis in type-2 diabetics with normal transaminases: A prospective cohort study. World J Gastroenterol 2021; 27(6): 523-533 [PMID: 33642826 DOI: 10.3748/wjg.v27.i6.523]
Corresponding Author of This Article
Jasbir Makker, MD, Attending Physician, Division of Gastroenterology, Department of Medicine, BronxCare Health System, 1650 Selwyn Avenue, Suite 10C, Bronx, NY 10457, United States. jmakker@bronxcare.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Feb 14, 2021; 27(6): 523-533 Published online Feb 14, 2021. doi: 10.3748/wjg.v27.i6.523
Prevalence of advanced liver fibrosis and steatosis in type-2 diabetics with normal transaminases: A prospective cohort study
Jasbir Makker, Hassan Tariq, Kishore Kumar, Madhavi Ravi, Danial Haris Shaikh, Vivien Leung, Umar Hayat, Muhammad T Hassan, Harish Patel, Suresh Nayudu, Sridhar Chilimuri
Jasbir Makker, Hassan Tariq, Kishore Kumar, Madhavi Ravi, Danial Haris Shaikh, Vivien Leung, Harish Patel, Suresh Nayudu, Sridhar Chilimuri, Division of Gastroenterology, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
Umar Hayat, KU School of Medicine-Wichita, University of Kansas, Wichita, KS 67214, United States
Muhammad T Hassan, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
Author contributions: Makker J and Tariq H designed and performed the study, analyzed the data, and drafted the manuscript; Kumar K and Ravi M collected the clinical data and performed Liver elastography; Hayat U and Patel H performed the bio statistical analysis; Shaikh DH, Hassan MT, Patel H and Leung V made critical revisions to the manuscript; Nayudu S and Chilimuri S supervised the study performance, reviewed the manuscript and gave final approval of the version of the article to be published.
Institutional review board statement: The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki, as reflected in the Bronx Care Health System Institutional Review Board’s approval (IRB #05 10 18 04).
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: All authors report no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jasbir Makker, MD, Attending Physician, Division of Gastroenterology, Department of Medicine, BronxCare Health System, 1650 Selwyn Avenue, Suite 10C, Bronx, NY 10457, United States. jmakker@bronxcare.org
Received: November 7, 2021 Peer-review started: November 7, 2020 First decision: December 3, 2020 Revised: December 12, 2020 Accepted: December 27, 2020 Article in press: December 27, 2020 Published online: February 14, 2021 Processing time: 90 Days and 10.2 Hours
Abstract
BACKGROUND
Nonalcoholic fatty liver disease (NAFLD) and type-2 diabetes mellitus (T2DM) have an intricate bidirectional relationship. Individuals with T2DM, not only have a higher prevalence of non-alcoholic steatosis, but also carry a higher risk of progression to nonalcoholic steatohepatitis. Experts still differ in their recommendations of screening for NAFLD among patients with T2DM.
AIM
To study the prevalence of NAFLD and advanced fibrosis among our patient population with T2DM.
METHODS
During the study period (November 2018 to January 2020), 59 adult patients with T2DM and 26 non-diabetic control group individuals were recruited prospectively. Patients with known significant liver disease and alcohol use were excluded. Demographic data and lab parameters were recorded. Liver elastography was performed in all patients.
RESULTS
In the study group comprised of patients with T2DM and normal alanine aminotransferase levels (mean 17.8 ± 7 U/L), 81% had hepatic steatosis as diagnosed by elastography. Advanced hepatic fibrosis (stage F3 or F4) was present in 12% of patients with T2DM as compared to none in the control group. Patients with T2DM also had higher number of individuals with grade 3 steatosis [45.8% vs 11.5%, (P < 0.00001) and metabolic syndrome (84.7% vs 11.5%, P < 0.00001)].
CONCLUSION
A significant number of patients with T2DM, despite having normal transaminase levels, have NAFLD, grade 3 steatosis and advanced hepatic fibrosis as measured by liver elastography.
Core Tip: Individuals with type 2 diabetes mellitus (T2DM) have a higher prevalence of non-alcoholic steatosis and a higher risk of progression to non-alcoholic steatohepatitis and cirrhosis. Experts differ in their screening recommendations for nonalcoholic fatty liver disease among patients with T2DM. We prospectively recruited and performed liver elastography on 59 diabetics and 26 non-diabetic control patients. Patients with known liver disease and alcohol use were excluded. Our study shows advanced fibrosis is prevalent among patients with T2DM as compared to non-diabetics, even with normal liver enzymes. Screening for liver fibrosis in all patients with T2DM should be considered, regardless of liver enzyme levels.
