Original Research Article
Year: 2017 | Month: March | Volume: 7 | Issue: 3 | Pages: 42-48
Study of Prevalence of Nonalcoholic Fatty Liver Disease [NAFLD] by Non Invasive Diagnostic Criteria in Type 2 Diabetes Mellitus Patients
Dr. Parth Patel1, Dr. Hetal Pandya2, Dr. Jaydutt Patel1, Dr Priyal Patel1
1Junior Resident, 2Head & Professor,
Department of General Medicine, S.B.K.S. Medical Institute & Research Center, Sumandeep Vidyapeeth, At & Post: Piparia, Vadodara, Gujarat, India.
Corresponding Author: Dr. Hetal Pandya
ABSTRACT
Introduction: Non-alcoholic fatty liver disease (NAFLD) and Non-alcoholic steatohepatitis (NASH) are the most common causes of liver disease in western countries. Prevalence of NAFLD is increasing even in developing countries mainly due to the increasing numbers of people with obesity or with metabolic syndrome and type 2 Diabetes Mellitus.
Methods: A total of 50 type 2 Diabetes Mellitus (DM) patients were evaluated for detailed history, demographic profile, anthropometric measurements, microvascular complications of type 2 DM, routine blood investigations, and tests for current glycemic status (FBS, PP2BS, HbA1C). Patients underwent ultrasonography to detect NAFLD. Serum transaminses (ALT and AST) levels were measured in all patients and ratio of AST/ALT was calculated to see sensitivity and specificity of same in comparision to ultrasonography.
Result: NAFLD was found in 32 (64%) patients out of 50 patients of type 2 DM by ultrasonography. Obesity and dyslipidemia, two important components of metabolic syndrome were found to have statistically significant association with occurrence of NAFLD in type 2 DM patients (p value: <0.01). Most of the patients (87.5%) in NAFLD type 2 DM group were having diabetes for more than 5 years so it seems likely that long duration of diabetes is at higher risk to develop NAFLD. There was highly statistically significant inverse relation between metformin therapy and development of NAFLD, (p value:< 0.001). It was noted that uncontrolled HbA1C level has association with increase prevalence of NAFLD (93.75%). type 2 DM patients with microvascular complications are at increased risk of developing NAFLD (p <0.005). Increased ALT levels (Sensitivity 59.38%, and Specificity 94.44%) and AST/ALT ratio less than one (Sensitivity 96.87% and Specificity 77.78%) were observed more frequently in NAFLD patients as compared to AST (Sensitivity 0 and Specificity 100%), so increased ALT and AST/ALT ratio can be used as biochemical marker to detect chronic liver disease such as NAFLD.
Conclusion: High prevalence of NAFLD is seen in Indian type 2 DM population. In our study we demonstrated the association between elements of metabolic syndrome, duration of diabetes, increase HbA1C level and microvascular complications of diabetes mellitus with occurrence of NAFLD. Metformin therapy may have protective role in development of NAFLD especially in type 2 DM. Our study also highlighted importance of evaluation of aminotransferases level in type 2 DM, which can be used as marker for chronic liver disease, like NAFLD in type 2 DM.
Key words: Type 2 Diabetes Mellitus, Non-alcoholic fatty liver disease (NAFLD).