Prevalence of Non Alcoholic Fatty Liver Disease in Type 2 Diabetic Patients with Assessment of Liver Fibrosis by Different Non-Invasive Methods

Author PMJN

Abstract


INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is quickly becoming one of the most prominent causes of liver disease worldwide and the incidence is increasing even in the developing part of world like ours. NAFLD is the hepatic manifestation of metabolic syndrome, and its prevalence is rising even in the developing world with increased frequency of DM, obesity.
METHOD: A hospital based observational study was conducted from October 2015 for six months period in the Liver Unit, NAMS, Nepal. All patients with known DM or newly diagnosed DM attending endocrine OPD after assessing the exclusion criteria were enrolled in the study. Fatty liver and its severity was identified by Ultrasonogram. All patients were subjected to fibroscan. Tests were done to calculate different fibrosis scores(NAFLD Fibrosis, BARD, FIB4) and compared with fibroscan score.
RESULT: Of 54 cases of which 55.6% were male and 44.6% were female. Mean age of the patient was 49.5 and 66.7% fall in 41-60 years group. About 75.9% had fatty liver among which 33.3% had mild fatty liver,31.5% had moderate fatty liver and 11.1% had severe fatty liver. Severe fatt y liver is common in pati ents with BMI of > 27.5. Metabolic syndrome was seen in about 44.4% of total patients. The mean of different fibrosis scores are slightly higher in patients with metabolic syndrome than without being NAFLD Fibrosis score=1.93, BARD score=2.88, FIB4 score=1.72 and fibroscan score=6.68 with insignifi cant P values. Low platelets count is correlated with high NAFLD Fibrosis score and FIB4 score with signifi cant P values of <0.001 whereas high AST/ALT ratio correlates only with BARD score with significant P value. NAFLD Fibrosis score and FIB 4 score correlates with significant P value of <0.01. In this study, fibroscan does not correlate with different fibrosis scores with insignifi cant P values being NAFLD Fibrosis score(P= 0.656), BARD score(P= 0.391) and FIB4(P=0.123).
CONCLUSION: The incidence and severity of NAFLD increase with higher BMI and the presence of metabolic syndrome. Fibroscan does not correlate with different non-invasive fibroscores like NAFLD fibrosis, BARD, FIB4 scores on contrary to the findings observed in different studies which may be due to smaller sample size and minimal fibrosis which can be underestimated by fibroscan. So, simple indirect tests like platelets count, AST/ALT ratio, FIB4 and NAFLD fi fibrosis scores derived from simple test can be used as a surrogate marker for fibrosis. Larger studies are needed to assess the fibrosis by different fibrosis scores with comparison to fibroscan.

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