TY - JOUR
T1 - Clinical spectrum of non-alcoholic fatty liver disease in diabetic and non-diabetic patients
AU - Goh, George Boon Bee
AU - Pagadala, Mangesh R.
AU - Dasarathy, Jaividhya
AU - Unalp-Arida, Aynur
AU - Sargent, Ruth
AU - Hawkins, Carol
AU - Sourianarayanane, Achuthan
AU - Khiyami, Amer
AU - Yerian, Lisa
AU - Pai, Rish K.
AU - Dasarathy, Srinivasan
AU - McCullough, Arthur J.
N1 - Funding Information:
No grant support was provided for this study.
Publisher Copyright:
© 2014 Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND 3.0 license.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Background: While non-alcoholic fatty liver disease (NAFLD) has been well characterised in patients with diabetes mellitus (DM), less is known about NAFLD in non-DM patients. We investigated the clinical characteristics of NAFLD patients with and without DM and accuracy of the NAFLD fibrosis score (NFS) in these two NAFLD groups. Methods: Clinical, biochemical and histological variables were evaluated in this prospective cross-sectional study of 503 patients with biopsy proven NAFLD. Comparisons between patients with and without DM were analysed. NFS was correlated with liver histology to assess its robustness in patients with and without DM. Results: There were 503 biopsy proven NAFLD patients with 48% of the cohort being diabetic. Relative to patients without DM, patients with DM were older (52 vs. 46. years, p. <. 0.001), with higher proportion of females (70% vs. 54%, p. <. 0.001), higher BMI (37 vs. 35, p = 0.009), higher prevalence of hypertension (73% vs. 44%, p. <. 0.001), higher prevalence of NASH (80.2% vs. 64.4%; p. <. 0.001) and advanced fibrosis (40.3% vs. 17.0%; p. <. 0.001). A considerable amount of patients without DM still had NASH (64%) and advanced fibrosis (17%). The clinical utility of the NFS differed between NAFLD patients with and without DM, with sensitivity to exclude advanced fibrosis being 90% of NAFLD patients with DM but only 58% of patients without DM. Conclusion: Patients with DM have more severe NAFLD based on histology. However, NASH and advanced fibrosis also occur in a considerable proportion of NAFLD patients without DM. The lower utility of the NFS in NAFLD patients without DM emphasises the heterogeneous nature of the NAFLD phenotype.
AB - Background: While non-alcoholic fatty liver disease (NAFLD) has been well characterised in patients with diabetes mellitus (DM), less is known about NAFLD in non-DM patients. We investigated the clinical characteristics of NAFLD patients with and without DM and accuracy of the NAFLD fibrosis score (NFS) in these two NAFLD groups. Methods: Clinical, biochemical and histological variables were evaluated in this prospective cross-sectional study of 503 patients with biopsy proven NAFLD. Comparisons between patients with and without DM were analysed. NFS was correlated with liver histology to assess its robustness in patients with and without DM. Results: There were 503 biopsy proven NAFLD patients with 48% of the cohort being diabetic. Relative to patients without DM, patients with DM were older (52 vs. 46. years, p. <. 0.001), with higher proportion of females (70% vs. 54%, p. <. 0.001), higher BMI (37 vs. 35, p = 0.009), higher prevalence of hypertension (73% vs. 44%, p. <. 0.001), higher prevalence of NASH (80.2% vs. 64.4%; p. <. 0.001) and advanced fibrosis (40.3% vs. 17.0%; p. <. 0.001). A considerable amount of patients without DM still had NASH (64%) and advanced fibrosis (17%). The clinical utility of the NFS differed between NAFLD patients with and without DM, with sensitivity to exclude advanced fibrosis being 90% of NAFLD patients with DM but only 58% of patients without DM. Conclusion: Patients with DM have more severe NAFLD based on histology. However, NASH and advanced fibrosis also occur in a considerable proportion of NAFLD patients without DM. The lower utility of the NFS in NAFLD patients without DM emphasises the heterogeneous nature of the NAFLD phenotype.
KW - Diabetic
KW - NAFLD
KW - NAFLD fibrosis score
KW - Non-diabetic
UR - http://www.scopus.com/inward/record.url?scp=84961290966&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84961290966&partnerID=8YFLogxK
U2 - 10.1016/j.bbacli.2014.09.001
DO - 10.1016/j.bbacli.2014.09.001
M3 - Article
C2 - 26675585
AN - SCOPUS:84961290966
SN - 2214-6474
VL - 3
SP - 141
EP - 145
JO - BBA Clinical
JF - BBA Clinical
ER -