Atherogenic dyslipidemia, but not hyperglycemia, is an independent factor associated with liver fibrosis in subjects with type 2 diabetes and NAFLD: a population-based study

in European Journal of Endocrinology
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  • 1 Department of Endocrinology and Nutrition, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
  • 2 Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain
  • 3 Centro d’Investigaciones Biomédicas en Red, Enfermedades Hepatologia y Digestivas, Barcelona, Spain
  • 4 Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
  • 5 Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
  • 6 Department of Biochemistry and Molecular Biology, Universitat Autònoma de Barcelona, Barcelona, Spain
  • 7 Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
  • 8 Hepatology Department, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
  • 9 Primary Health Care Center Raval Sud, Gerència d’Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
  • 10 Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida, USA
  • 11 Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
  • 12 Faculty of Medicine, University of Vic, Central University of Catalonia, Vic, Spain

Correspondence should be addressed to D Mauricio or N Alonso; Email: didacmauricio@gmail.com or nurialonsopedrol@gmail.com
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Objective

To investigate the prevalence and risks factors associated with the presence of liver fibrosis in subjects with nonalcoholic fatty liver disease (NAFLD) with and without type 2 diabetes mellitus (T2D).

Design and methods

This study was part of a population-based study conducted in the Barcelona metropolitan area among subjects aged 18–75 years old. Secondary causes of steatosis were excluded. Moderate-to-advanced liver fibrosis was defined as a liver stiffness measurement (LSM) ≥ 8.0 kPa assessed by transient elastography.

Results

Among 930 subjects with NAFLD, the prevalence of moderate-to-advanced liver fibrosis was higher in subjects with T2D compared those without (30.8% vs 8.7%). By multivariable analysis, one of the main factors independently associated with increased LSM in subjects with NAFLD was atherogenic dyslipidemia but only in those with T2D. The percentage of subjects with LSM ≥ 8.0 kPa was higher in subjects with T2D and atherogenic dyslipidemia than in those with T2D without atherogenic dyslipidemia both for the cut-off point of LSM ≥8.0 kPa (45% vs 24% P = 0.002) and ≥13 kPa (13% vs 4% P = 0.020). No differences were observed in the prevalence of LSM ≥8.0 kPa regarding glycemic control among NAFLD-diabetic subjects.

Conclusions

Factors associated with moderate-to-advanced liver fibrosis in NAFLD are different in subjects with and without T2D. Atherogenic dyslipidemia was associated with the presence of moderate-to-advanced liver fibrosis in T2D with NAFLD but not in non-diabetic subjects. These findings highlight the need for an active search for liver fibrosis in subjects with T2D NAFLD and atherogenic dyslipidemia.

Supplementary Materials

    • SUPPLEMENTARY TABLE 1. Baseline characteristics of the study population (n=2506)
    • SUPPLEMENTARY TABLE 2. Prevalence of atherosclerotic cardiovascular events in subjects with NAFLD with and without atherogenic dyslipidemia.
    • SUPPLEMENTARY TABLE 3. Baseline characteristics in subjects with and without NAFLD.
    • SUPPLEMENTARY TABLE 4. Multivariate Analysis of factors associated with NAFLD
    • SUPPLEMENTARY TABLE 5. Multivariate analysis of factors associated with advanced liver fibrosis (LSM ≥ 13 kPa) in subjects with NAFLD comparing subjects with and without T2D.
    • SUPPLEMENTARY TABLE 6. Baseline characteristics in subjects without T2D with NAFLD with and without liver fibrosis (LSM ≥ 8.0 kPa)
    • SUPPLEMENTARY FIGURE 1. Flow chart of the study
    • Supplementary Figure 2. Prevalence of LSM <8.0 kPa (white bars) vs. &#x2265;8.0 kPa (Black bars) according to the presence or not of NAFLD and T2D in the 2.506 included subjects. Abbreviations: LSM: liver stiffness measurement

 

     European Society of Endocrinology

Sept 2018 onwards Past Year Past 30 Days
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