Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2021; 9(26): 7717-7728
Published online Sep 16, 2021. doi: 10.12998/wjcc.v9.i26.7717
Influencing factors for hepatic fat accumulation in patients with type 2 diabetes mellitus
Meng-Jiao Wu, Qiong-Lei Fang, Sheng-Yi Zou, Yan Zhu, Wen Lu, Xuan Du, Bi-Min Shi
Meng-Jiao Wu, Qiong-Lei Fang, Sheng-Yi Zou, Yan Zhu, Wen Lu, Xuan Du, Bi-Min Shi, Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
Author contributions: Wu MJ and Fang QL contributed equally to this study; Du X and Shi BM developed the study concept and design; Wu MJ and Fang QL mainly implemented the study; Wu MJ, Lu W, Zou SY, Zhu Y, and Fang QL registered the study patients and performed physical examination and medical treatments; Wu MJ and Zhu Y were responsible for measuring plasma lipid parameters; Wu MJ and Du X drafted the manuscript and performed statistical analyses; Wu MJ, Fang QL, and Du X interpreted the data and critically revised and completed the manuscript; all authors read and approved the submitted manuscript.
Supported by Suzhou Health Committee and Science and Technology Bureau, No. KJXW2019005.
Institutional review board statement: The study was approved by the Institutional Review Board of the First Affiliated Hospital of Soochow University, and written informed consent was obtained from all participating patients before the initiation of the study.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have nothing to disclose.
Data sharing statement: The datasets analyzed in current study are not publicly available due to relevant ongoing studies, but may be available from the corresponding authors upon reasonable request.
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: Xuan Du, MD, Doctor, Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, No.188 Shizi street, Suzhou 215000, Jiangsu Province, China, cathy-dx0630@163.com
Received: March 24, 2021
Peer-review started: March 24, 2021
First decision: May 12, 2021
Revised: May 23, 2021
Accepted: July 23, 2021
Article in press: July 23, 2021
Published online: September 16, 2021
ARTICLE HIGHLIGHTS
Research background

Non-alcoholic fatty liver disease (NAFLD), the most common hepatic chronic disease worldwide, has been considered to have a complex association with type 2 diabetes mellitus (T2DM). The existence of NAFLD disturbs the homeostasis of glucose metabolism, while patients with T2DM have a higher prevalence of hepatic steatosis, which is the origin of further adverse pathological changes.

Research motivation

In previous clinical studies focused on NAFLD, most diagnoses of hepatic steatosis were conducted using common imaging techniques such as ultrasound and computed tomography, which have limited diagnostic sensitivity and accuracy under certain circumstances. There is an urgent need for a rapid, non-invasive, and inexpensive technique to precisely quantify hepatic fat content and to grade the severity of hepatic steatosis for future NAFLD research.

Research objectives

We aimed to quantify the hepatic triglyceride (TG) content and then investigate the influencing factors for hepatic fat accumulation and the severity of fatty liver in T2DM patients.

Research methods

A cross-sectional study was conducted at the department of endocrinology, including 329 hospitalized T2DM patients divided into three groups according to their body mass index (BMI). MR mDIXON-Quant imaging was applied to quantify the hepatic fat fraction (HFF) of each patient, and fasting blood samples were obtained for further biochemical analysis. HFF, anthropometric data, and laboratory characteristics were compared among the three groups. Spearman correlation analysis and linear regression analysis were carried out to determine the associations between HFF and other variables, and binary logistic regression analysis was carried out to find out the influencing factors for severer hepatic steatosis in T2DM patients.

Research results

The HFF of T2DM patients gradually increased in the normal weight (BMI of 18.5-23.9 kg/m2), overweight weight (BMI of 24.0-27.9 kg/m2), and obese groups (BMI ≥ 28.0 kg/m2). Spearman correlation analysis and multivariate linear regression analysis showed that BMI, alanine aminotransferase (ALT), albumin (ALB), low-density lipoprotein cholesterol (LDL-C), and uric acid had significant positive associations with HFF of T2DM patients. Multivariate binary logistic regression analysis showed that BMI, ALT, ALB, and LDL-C were independent risk factors for moderate to severe fatty liver in T2DM patients. Overweight and obesity increased the odds ratio of severer fatty liver by 2.29 times and 5.03 times, respectively, in T2DM patients.

Research conclusions

We quantified hepatic TG content and graded the severity of hepatic steatosis by MR mDIXON-Quant imaging technique. We found that in T2DM patients, hepatic fat accumulation is significantly associated with increasing BMI, ALT, ALB, and LDL-C. Higher BMI, ALT, ALB, and LDL-C are independent risk factors for moderate to severe non-alcoholic fatty liver in T2DM patients.

Research perspectives

Considering of the small size of subjects and the limitation of cross-sectional study, prospective studies with larger size of subjects are needed to verify our findings. However, we would like to recommend the MR mDIXON-Quant imaging as an excellent tool for the diagnosis and grading of non-alcoholic hepatic steatosis, which might play an important role in future research and clinical practice of NAFLD.