Transient elastography for the prevalence of non-alcoholic fatty liver disease in patients with type 2 diabetes: Evidence from the CORDIAL cohort study
Assim A Alfadda1, Suphia M Sherbeeni2, Adel N Alqutub3, Abdullah S Aldosary4, Nasser M Aldaghri5, Simon D Taylor-Robinson6, Saleh A Alqahtani7, Rukhsana Gul8, Abdulrahman M Almaghamsi9
1 Obesity Research Center; Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2 Tadaw Medical Complex and Day Surgery Center, Riyadh, Saudi Arabia
3 Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
4 Department of Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
5 Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
6 Department of Surgery and Cancer, St. Mary's Hospital Campus, Imperial College London, London, United Kingdom
7 Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA
8 Obesity Research Center, King Saud University, Riyadh, Saudi Arabia
9 Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
Assim A Alfadda,
Obesity Research Center, College of Medicine, King Saud University, P. O. Box 2925 (98), Riyadh - 11461
Source of Support: None, Conflict of Interest: None
Background: Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate the prevalence of NAFLD among Saudi patients with T2DM using transient elastography.
Methods: A total of 490 patients with T2DM who attended diabetes and primary care clinics were recruited. Controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) were obtained via FibroScan to assess steatosis and fibrosis.
Results: Of the examined 490 patients with T2DM, 396 (80.8%) had hepatic steatosis (CAP ≥248 dB/m): 326 (66.5%) had severe steatosis (CAP ≥280 dB/m), while 41 (8.4%) and 29 (5.9%) had mild (CAP ≥248 to <268 dB/m) and moderate steatosis (CAP ≥268 to <280 dB/m), respectively. Of the 396 patients with steatosis, only 35 (8.8%) had LSM ≥7.9 kPa, suggesting the presence of fibrosis, while 361 (91%) had LSM <7.9 kPa, indicating the absence of fibrosis. Increased body mass index (BMI), waist circumference, systolic blood pressure (SBP), and alanine aminotransferase (ALT) were positively associated with both steatosis and fibrosis. After adjusting for age and gender, data from logistic regression analysis demonstrated BMI, waist circumference, SBP, ALT, and high-density lipoprotein (HDL) as significant independent factors for steatosis, while SBP was the only significant predictor associated with fibrosis.
Conclusions: Our results demonstrate an increase in prevalence of NAFLD in Saudi patients with T2DM, based on transient elastography and CAP score. The risk of NAFLD appears to be higher in T2DM patients with abdominal obesity, elevated SBP, and increased ALT levels, which supports the screening of these conditions in patients with T2DM.