Clinical spectrum of non-alcoholic fatty liver disease in diabetic and non-diabetic patients

George Boon Bee Goh, Mangesh R. Pagadala, Jaividhya Dasarathy, Aynur Unalp-Arida, Ruth Sargent, Carol Hawkins, Achuthan Sourianarayanane, Amer Khiyami, Lisa Yerian, Rish K. Pai, Srinivasan Dasarathy, Arthur J. McCullough

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)141-145
Number of pages5
JournalBBA Clinical
StatePublished - Jun 1 2015


  • Diabetic
  • NAFLD fibrosis score
  • Non-diabetic

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Molecular Medicine
  • Physiology (medical)


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