Prospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
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:
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.
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
Research background

With the current obesity epidemic, prevalence of non-alcoholic fatty liver disease (NAFLD) has increased. Individuals with type 2 diabetes mellitus (T2DM) have a higher prevalence of non-alcoholic steatosis, may carry a higher risk of progression to nonalcoholic steatohepatitis and eventually cirrhosis.

Research motivation

Experts still differ in their recommendations of screening for NAFLD among patients with T2DM.

Research objectives

To study the prevalence of NAFLD and advanced fibrosis among our patient population with T2DM with normal transaminases and without known liver disease.

Research methods

Prospective cohort study assessing hepatic steatosis and fibrosis using transient elastography in 59 patients with T2DM, compared to 26 non-diabetic control group patients.

Research results

In our study group, 81% of patients had hepatic steatosis and 12% had advanced fibrosis on liver elastography. In the control group none of the patients had advanced stage fibrosis. Grade 3 steatosis was prevalent in 46% of patients in the study group as compared to 12% patients in the control group (P value < 0.00001).

Research conclusions

A significant number of patients with T2DM, despite having normal transaminase levels, have advanced fibrosis or steatosis as measured by liver elastography.

Research perspectives

Physicians should be aware of prevalence of significant liver disease among patients with T2DM, even with normal liver enzymes and should consider earlier screening to prevent presentation at advanced stages of fibrosis. Larger studies are needed to confirm and validate our results.