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 M Julián, Endocrinology and Nutrition, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
  • 2 G Pera, Statistical, 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 B Soldevila, Endocrinology and Nutrition, Hospital Germans Trias i Pujol, Badalona, Spain
  • 4 L Caballería, Atención Primaria , 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, Mataró, Spain
  • 5 J Julve, Biochemistry and molecular biology, Hospital de la Santa Creu i Sant Pau, and Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona , Spain
  • 6 C Puig-Jové, Endocrinology and Nutrition, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
  • 7 R Morillas , Hepatology, Hospital Germans Trias i Pujol, Badalona, Spain
  • 8 P Torán , Atención primaria , 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, Mataró, Spain
  • 9 C Expósito , Atención Primaria , 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
  • 10 M Puig-Domingo, Department of Endocrinology and Nutrition, Hospital Germans Trias i Pujol, Badalona, Spain
  • 11 E Castelblanco, Endocrinology, Hospital de la Santa Creu i Sant Pau, and Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
  • 12 J Franch-Nadal, Atención primaria, Primary Health Care Center Raval Sud, Gerència d'Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
  • 13 K Cusi, Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, United States
  • 14 D Mauricio, Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, and Institut d’Investigació Biomèdica Sant Pau, Barcelona, Spain
  • 15 N Alonso, Endocrinology and Nutrition, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

Correspondence: Nuria Alonso, Email: nurialonsopedrol@gmail.com
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Objective: To investigate the prevalence and risks factors associated with the presence of significant 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.

 

     European Society of Endocrinology