Prevalence of non-alcoholic fatty liver disease in patients with prediabetes

Main Article Content

Bhumi Agarwal
B.M. Singh Lamba
Neera Sharma
Monika Tanwar

Abstract

Background. Diabetes mellitus (DM) is one of the largest global health emergencies. Prediabetes is an early stage in hyperglycemia continuum where individual is at an increased risk for development of DM. NAFLD represents a range of liver disorders characterized by hepatic steatosis or accumulation of fat in the liver cells in the absence of excessive alcohol consumption, viral or drug related etiologies. However, not many studies have been conducted to study the prevalence of non-alcoholic fatty liver disease (NAFLD) in persons with prediabetes. This study is an endeavor in that direction. Materials and methods. This was a cross-sectional observational study. 100 prediabetic patients, fulfilling the criteria as under, were included in the study over a period from November 2017 to March 2019, after informed consent. Investigations carried out on the patients included baseline biochemical parameters like complete hemogram, fasting plasma glucose, liver function tests, kidney function tests, serum electrolytes and specialized investigations like HbA1c, 2-hour-OGTT and serum insulin levels. Results. The study included 38 males and 62 females, with the median age for the study population being 46 years. The mean BMI was found to be 24.29 ± 3.98 kg/m2, and the mean waist circumference was found to be 81.26 ± 8.71 cm. A significant association was found between the level of fatty echotexture on ultrasound and BMI (p = 0.003), and gender (0.05). 30 % population was found to be insulin sensitive, 22 % was found to be depicting early insulin resistance and 48 % had significant insulin resistance. There was a statistically significant correlation between ultrasound and fibroscan findings. A significant statistical correlation was found between HOMA IR and level of fatty echotexture on ultrasound, as well as median liver stiffness on fibroscan. Conclusions. We found a significant correlation between insulin resistance and presence of NAFLD. Also, significant associations were observed between various demographic characteristics and grade of steatosis. There is a need to undertake further studies on a larger scale, to substantiate the observations of this study. This understanding is expected to go a long way in generating awareness and optimizing public health strategies.

Article Details

How to Cite
Agarwal, B., B. Singh Lamba, N. Sharma, and M. Tanwar. “Prevalence of Non-Alcoholic Fatty Liver Disease in patients With Prediabetes”. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), vol. 17, no. 1, Apr. 2021, pp. 26-31, doi:10.22141/2224-0721.17.1.2021.226427.
Section
Original Researches

References

Saeedi P, Petersohn I, Salpea P, et al; IDF Diabetes Atlas Committee. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019 Nov;157:107843. doi:10.1016/j.diabres.2019.107843.

American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021 Jan;44(Suppl 1):S15-S33. doi:10.2337/dc21-S002.

Wu WC, Wei JN, Chen SC, et al. Progression of insulin resistance: A link between risk factors and the incidence of diabetes. Diabetes Res Clin Pract. 2020 Mar;161:108050. doi:10.1016/j.diabres.2020.108050.

Neuschwander-Tetri BA. Therapeutic Landscape for NAFLD in 2020. Gastroenterology. 2020 May;158(7):1984-1998.e3. doi:10.1053/j.gastro.2020.01.051.

Taylor RS, Taylor RJ, Bayliss S, et al. Association Between Fibrosis Stage and Outcomes of Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis. Gastroenterology. 2020 May;158(6):1611-1625.e12. doi:10.1053/j.gastro.2020.01.043.

Ortiz-Lopez C, Lomonaco R, Orsak B, et al. Prevalence of prediabetes and diabetes and metabolic profile of patients with nonalcoholic fatty liver disease (NAFLD). Diabetes Care. 2012 Apr;35(4):873-8. doi:10.2337/dc11-1849.

Mansour-Ghanaei F, Jafarinejad A, Roshan ZA, Khosravi H, Hassankhani A, Amir-Maafi A. Non-Alcoholic Fatty Liver Disease and Prediabetes. J Pioneer Med Sci. 2016;6(1):6-9.

Stefan N, Staiger H, Wagner R, et al. A high-risk phenotype associates with reduced improvement in glycaemia during a lifestyle intervention in prediabetes. Diabetologia. 2015 Dec;58(12):2877-84. doi:10.1007/s00125-015-3760-z.

Mohan V, Farooq S, Deepa M, Ravikumar R, Pitchumoni CS. Prevalence of non-alcoholic fatty liver disease in urban south Indians in relation to different grades of glucose intolerance and metabolic syndrome. Diabetes Res Clin Pract. 2009 Apr;84(1):84-91. doi:10.1016/j.diabres.2008.11.039.

Suresh S, Rajanbabu B, Veetil VM, Hussain A, Veetil JN. A study on the altered glycemic and lipid parameters and prevalence of insulin resistance in nonalcoholic fatty liver disease. J Family Med Prim Care. 2018 Jan-Feb;7(1):93-97. doi:10.4103/jfmpc.jfmpc_352_16.

Bugianesi E, Gastaldelli A, Vanni E, et al. Insulin resistance in non-diabetic patients with non-alcoholic fatty liver disease: sites and mechanisms. Diabetologia. 2005 Apr;48(4):634-42. doi:10.1007/s00125-005-1682-x.

Nassir F, Rector RS, Hammoud GM, Ibdah JA. Pathogenesis and Prevention of Hepatic Steatosis. Gastroenterol Hepatol (N Y). 2015 Mar;11(3):167-75.

Xia W, Pessentheiner AR, Hofer DC, et al. Loss of ABHD15 Impairs the Anti-lipolytic Action of Insulin by Altering PDE3B Stability and Contributes to Insulin Resistance. Cell Rep. 2018 May 15;23(7):1948-1961. doi:10.1016/j.celrep.2018.04.055.

Rhee EJ, Lee WY, Cho YK, Kim BI, Sung KC. Hyperinsulinemia and the development of nonalcoholic Fatty liver disease in nondiabetic adults. Am J Med. 2011 Jan;124(1):69-76. doi:10.1016/j.amjmed.2010.08.012.

Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012 Jun;55(6):2005-23. doi:10.1002/hep.25762.

Zhang GL, Zhao QY, Lin CS, Hu ZX, Zhang T, Gao ZL. Transient Elastography and Ultrasonography: Optimal Evaluation of Liver Fibrosis and Cirrhosis in Patients with Chronic Hepatitis B Concurrent with Nonalcoholic Fatty Liver Disease. Biomed Res Int. 2019 Jan 23;2019:3951574. doi:10.1155/2019/3951574.

Bedogni G, Miglioli L, Masutti F, Tiribelli C, Marchesini G, Bellentani S. Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study. Hepatology. 2005 Jul;42(1):44-52. doi:10.1002/hep.20734.

Summart U, Thinkhamrop B, Chamadol N, Khuntikeo N, Songthamwat M, Kim CS. Gender differences in the prevalence of nonalcoholic fatty liver disease in the Northeast of Thailand: A population-based cross-sectional study. F1000Res. 2017 Sep 4;6:1630. doi:10.12688/f1000research.12417.2.

Liu M, Wang J, Zeng J, Cao X, He Y. Association of NAFLD With Diabetes and the Impact of BMI Changes: A 5-Year Cohort Study Based on 18,507 Elderly. J Clin Endocrinol Metab. 2017 Apr 1;102(4):1309-1316. doi:10.1210/jc.2016-3440.

Privitera G, Spadaro L, Alagona C, et al. Hepatic insulin resistance in NAFLD: relationship with markers of atherosclerosis and metabolic syndrome components. Acta Diabetol. 2016 Jun;53(3):449-59. doi:10.1007/s00592-015-0816-y.

Li M, Zhang S, Wu Y, et al. Prevalence of Insulin Resistance in Subjects with Nonalcoholic Fatty Liver Disease and Its Predictors in a Chinese Population. Dig Dis Sci. 2015 Jul;60(7):2170-6. doi:10.1007/s10620-015-3564-5.

Singh Y, Garg MK, Tandon N, Marwaha RK. A study of insulin resistance by HOMA-IR and its cut-off value to identify metabolic syndrome in urban Indian adolescents. J Clin Res Pediatr Endocrinol. 2013;5(4):245-51. doi:10.4274/Jcrpe.1127.