scholarly journals Advanced Liver Fibrosis Is Common in Patients With Type 2 Diabetes Followed in the Outpatient Setting: The Need for Systematic Screening

Diabetes Care ◽  
2020 ◽  
pp. dc201997
Author(s):  
Romina Lomonaco ◽  
Eddison Godinez Leiva ◽  
Fernando Bril ◽  
Sulav Shrestha ◽  
Lydia Mansour ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Liver Fibrosis ◽  
Outpatient Setting ◽  
Systematic Screening ◽  
Advanced Liver Fibrosis

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

2021 ◽  
Author(s):  
María Teresa Julián ◽  
Guillem Pera ◽  
Berta Soldevila ◽  
Llorenç Caballería ◽  
Josep Julve ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Liver Fibrosis ◽  
Multivariable Analysis ◽  
Liver Stiffness ◽  
Population Based ◽  
Atherogenic Dyslipidemia ◽  
Population Based Study ◽  
Factors Associated ◽  
Advanced Liver Fibrosis

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.

Advanced liver fibrosis predicts poor cardiovascular outcomes in patients with type 2 diabetes

2020 ◽  
Vol 73 ◽  
pp. S155-S156
Author(s):  
Ho Soo Chun ◽  
Hye Yeon Chon ◽  
Jae Seung Lee ◽  
Hye Won Lee ◽  
Beom Kyung Kim ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Liver Fibrosis ◽  
Cardiovascular Outcomes ◽  
Advanced Liver Fibrosis

Increasing aortic stiffness is predictive of advanced liver fibrosis in patients with type 2 diabetes: the Rio-T2DM cohort study

2015 ◽  
Vol 36 (7) ◽  
pp. 977-985 ◽  
Author(s):  
Nathalie C. Leite ◽  
Cristiane A. Villela-Nogueira ◽  
Marcel T. Ferreira ◽  
Claudia R. L. Cardoso ◽  
Gil F. Salles
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Liver Fibrosis ◽  
Aortic Stiffness ◽  
Advanced Liver Fibrosis

scholarly journals Advanced Liver Fibrosis Is Common in Patients With Type 2 Diabetes Followed in the Outpatient Setting: The Need for Systematic Screening

2020 ◽  
Author(s):  
Romina Lomonaco ◽  
Eddison Godinez Leiva ◽  
Fernando Bril ◽  
Sulav Shrestha ◽  
Lydia Mansour ◽  
...  
Keyword(s):  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Transient Elastography ◽  
Outpatient Setting ◽  
Plasma Diagnostic ◽  
Advanced Fibrosis ◽  
Systematic Screening ◽  
Established Risk Factor ◽  
Advanced Liver Fibrosis ◽  
Clinically Significant

<b>Objective:</b> Assess the prevalence of NAFLD and of liver fibrosis associated with nonalcoholic steatohepatitis (NASH) in unselected patients with T2DM. <p><b>Research Design and Methods:</b> 561 patients with T2DM (age: 60±11; BMI: 33.4±6.2 kg/m<sup>2</sup>; HbA1c: 7.5±1.8%) attending primary care or endocrinology outpatient clinics and unaware of having NAFLD. At the visit, volunteers were invited to be screened by elastography for steatosis and fibrosis by CAP (≥274 dB/m) and LSM (≥7.0 kPa), respectively. Secondary causes of liver disease were ruled out. Diagnostic panels for prediction of advanced fibrosis, such as APRI and FIB-4, were also measured. A liver biopsy was performed if results were suggestive of fibrosis.</p> <p><b>Results:</b> The prevalence of steatosis was 70% and of fibrosis 21% (LSM≥7.0 kPa). Moderate fibrosis (F2: LSM≥8.2 kPa) was present in 6% and severe fibrosis or cirrhosis (F3-4: LSM≥9.7 kPa) in 9%, similar to that estimated by FIB-4 and APRI panels. Non-invasive testing was consistent with liver biopsy results. Elevated AST or ALT ≥40 U/L were present in a minority of patients with steatosis (8% and 13%, respectively) or with liver fibrosis (18% and 28%, respectively). This suggests that AST/ALT alone are insufficient as initial screening. However, performance may be enhanced by imaging (e.g., transient elastography) and plasma diagnostic panels (e.g., FIB-4, APRI).</p> <p><b>Conclusions: </b>Moderate-to-advanced fibrosis (F≥2), an established risk factor for cirrhosis and overall mortality, affects at least one-out-of-six (15%) patients with T2DM. These results support the ADA guidelines to screen for clinically significant fibrosis in patients with T2DM with steatosis or elevated ALT.</p>

scholarly journals Advanced Liver Fibrosis Is Common in Patients With Type 2 Diabetes Followed in the Outpatient Setting: The Need for Systematic Screening

2021 ◽  
Author(s):  
Romina Lomonaco ◽  
Eddison Godinez Leiva ◽  
Fernando Bril ◽  
Sulav Shrestha ◽  
Lydia Mansour ◽  
...  
Keyword(s):  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Transient Elastography ◽  
Outpatient Setting ◽  
Plasma Diagnostic ◽  
Advanced Fibrosis ◽  
Systematic Screening ◽  
Established Risk Factor ◽  
Advanced Liver Fibrosis ◽  
Clinically Significant

<b>Objective:</b> Assess the prevalence of NAFLD and of liver fibrosis associated with nonalcoholic steatohepatitis (NASH) in unselected patients with T2DM. <p><b>Research Design and Methods:</b> 561 patients with T2DM (age: 60±11; BMI: 33.4±6.2 kg/m<sup>2</sup>; HbA1c: 7.5±1.8%) attending primary care or endocrinology outpatient clinics and unaware of having NAFLD. At the visit, volunteers were invited to be screened by elastography for steatosis and fibrosis by CAP (≥274 dB/m) and LSM (≥7.0 kPa), respectively. Secondary causes of liver disease were ruled out. Diagnostic panels for prediction of advanced fibrosis, such as APRI and FIB-4, were also measured. A liver biopsy was performed if results were suggestive of fibrosis.</p> <p><b>Results:</b> The prevalence of steatosis was 70% and of fibrosis 21% (LSM≥7.0 kPa). Moderate fibrosis (F2: LSM≥8.2 kPa) was present in 6% and severe fibrosis or cirrhosis (F3-4: LSM≥9.7 kPa) in 9%, similar to that estimated by FIB-4 and APRI panels. Non-invasive testing was consistent with liver biopsy results. Elevated AST or ALT ≥40 U/L were present in a minority of patients with steatosis (8% and 13%, respectively) or with liver fibrosis (18% and 28%, respectively). This suggests that AST/ALT alone are insufficient as initial screening. However, performance may be enhanced by imaging (e.g., transient elastography) and plasma diagnostic panels (e.g., FIB-4, APRI).</p> <p><b>Conclusions: </b>Moderate-to-advanced fibrosis (F≥2), an established risk factor for cirrhosis and overall mortality, affects at least one-out-of-six (15%) patients with T2DM. These results support the ADA guidelines to screen for clinically significant fibrosis in patients with T2DM with steatosis or elevated ALT.</p>

scholarly journals Prognostic impact of liver fibrosis and steatosis by transient elastography for cardiovascular and mortality outcomes in individuals with nonalcoholic fatty liver disease and type 2 diabetes: the Rio de Janeiro Cohort Study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Claudia R. L. Cardoso ◽  
Cristiane A. Villela-Nogueira ◽  
Nathalie C. Leite ◽  
Gil F. Salles
Keyword(s):  
Type 2 Diabetes ◽  
Liver Fibrosis ◽  
Protective Factor ◽  
Transient Elastography ◽  
Cardiovascular Complications ◽  
Risk Marker ◽  
Continuous Variables ◽  
Nonalcoholic Fatty Liver ◽  
Advanced Liver Fibrosis

Abstract Background Liver stiffness measurement (LSM, which reflects fibrosis) and controlled attenuation parameter (CAP, which reflects steatosis), two parameters derived from hepatic transient elastography (TE), have scarcely been evaluated as predictors of cardiovascular complications and mortality in individuals with type 2 diabetes and nonalcoholic fatty liver disease (NAFLD). Methods Four hundred type 2 diabetic patients with NAFLD had TE examination (by Fibroscan®) performed at baseline. Multivariate Cox analyses evaluated the associations between TE parameters and the occurrence of cardiovascular events (CVEs) and mortality. TE parameters were assessed as continuous variables and dichotomized at low/high values reflecting advanced liver fibrosis (LSM > 9.6 kPa) and severe steatosis (CAP > 296 or > 330 dB/m). Improvements in risk discrimination were assessed by C-statistic and by the relative Integrated Discrimination Improvement (IDI) index. Results During a median follow-up of 5.5 years, 85 patients died (40 from cardiovascular causes), and 69 had a CVE. As continuous variables, an increasing LSM was a risk marker for total CVEs (hazard ratio [HR]: 1.05; 95% CI: 1.01–1.08) and all-cause mortality (HR: 1.04; 95% CI: 1.01–1.07); whereas an increasing CAP was a protective factor for both outcomes (HR: 0.93; 95% CI: 0.89–0.98; and HR: 0.92; 95% CI: 0.88–0.97; respectively). As dichotomized variables, a high LSM remained a risk marker of adverse outcomes (with HRs ranging from 2.5 to 3.0) and a high CAP was protective (with HRs from 0.3 to 0.5). The subgroup of individuals with low-LSM/high-CAP had the lowest risks while the opposite subgroup with high-LSM/low-CAP had the highest risks. Both LSM and CAP improved risk discrimination, with increases in C-statistics up to 0.037 and IDIs up to 52%. Conclusions Measured by hepatic TE, advanced liver fibrosis is a risk marker and severe steatosis is a protective factor for cardiovascular complications and mortality in individuals with type 2 diabetes and NAFLD.

scholarly journals Advanced Liver Fibrosis Is Common in Patients With Type 2 Diabetes Followed in the Outpatient Setting: The Need for Systematic Screening

2021 ◽  
Author(s):  
Romina Lomonaco ◽  
Eddison Godinez Leiva ◽  
Fernando Bril ◽  
Sulav Shrestha ◽  
Lydia Mansour ◽  
...  
Keyword(s):  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Transient Elastography ◽  
Outpatient Setting ◽  
Plasma Diagnostic ◽  
Advanced Fibrosis ◽  
Systematic Screening ◽  
Established Risk Factor ◽  
Advanced Liver Fibrosis ◽  
Clinically Significant

<b>Objective:</b> Assess the prevalence of NAFLD and of liver fibrosis associated with nonalcoholic steatohepatitis (NASH) in unselected patients with T2DM. <p><b>Research Design and Methods:</b> 561 patients with T2DM (age: 60±11; BMI: 33.4±6.2 kg/m<sup>2</sup>; HbA1c: 7.5±1.8%) attending primary care or endocrinology outpatient clinics and unaware of having NAFLD. At the visit, volunteers were invited to be screened by elastography for steatosis and fibrosis by CAP (≥274 dB/m) and LSM (≥7.0 kPa), respectively. Secondary causes of liver disease were ruled out. Diagnostic panels for prediction of advanced fibrosis, such as APRI and FIB-4, were also measured. A liver biopsy was performed if results were suggestive of fibrosis.</p> <p><b>Results:</b> The prevalence of steatosis was 70% and of fibrosis 21% (LSM≥7.0 kPa). Moderate fibrosis (F2: LSM≥8.2 kPa) was present in 6% and severe fibrosis or cirrhosis (F3-4: LSM≥9.7 kPa) in 9%, similar to that estimated by FIB-4 and APRI panels. Non-invasive testing was consistent with liver biopsy results. Elevated AST or ALT ≥40 U/L were present in a minority of patients with steatosis (8% and 13%, respectively) or with liver fibrosis (18% and 28%, respectively). This suggests that AST/ALT alone are insufficient as initial screening. However, performance may be enhanced by imaging (e.g., transient elastography) and plasma diagnostic panels (e.g., FIB-4, APRI).</p> <p><b>Conclusions: </b>Moderate-to-advanced fibrosis (F≥2), an established risk factor for cirrhosis and overall mortality, affects at least one-out-of-six (15%) patients with T2DM. These results support the ADA guidelines to screen for clinically significant fibrosis in patients with T2DM with steatosis or elevated ALT.</p>

Sign in / Sign up

Export Citation Format

Share Document