Fibrosis stage, fat score increase risk for type 2 diabetes in NAFLD patients
In a retrospective study, researchers observed an association between stage 3 and 4 fibrosis and histologic fat scores in stage 0 to 2 and increased risk for type 2 diabetes in patients with nonalcoholic fatty liver disease.
“Finding [type 2 diabetes] early in the process could allow for more intense treatment and lifestyle modifications, which could reduce future morbidity and mortality,” the researchers wrote. “With the vast number of patients with NAFLD, it is vital to identify relevant risk factors associated with the development of [type 2 diabetes] to be able to focus resources on high-risk patient groups for [diabetes] screening.”
The researchers gathered data on 396 patients with biopsy-confirmed NAFLD between 1971 and 2009. Mean patient age was 45.8 years, 257 were men, mean BMI was 27.5 kg/m2 and mean follow-up was 18.4 years (range, 0-41 years).
During follow-up, 132 patients developed type 2 diabetes for an incidence rate of 18 cases per 1,000 person-years. Further analysis of incidence rates showed development of type 2 diabetes occurred at a rate of 5.1% after 5 years, 10.3% after 10 years and 16.9% after 15 years.
Thirty-nine patients had fibrosis at stage 3 or 4. These patients were more likely to develop type 2 diabetes compared with patients with fibrosis at stage 0 to 2 (51.2% vs. 31.3%; P = .02). Significant risk factors included BMI (HR = 1.4; 95% CI, 1.01-1.29) and cholesterol over 240 mmol/L (HR = 1.02; 95% CI, 1-1.04).
For patients with fibrosis stage 0 to 2, significant factors related to the development of type 2 diabetes included age (HR = 1.02; 95% CI, 1.01-1.04), triglycerides over 150 mg/dL (HR = 1.78; 95% CI, 1.01-2.92), fat score (HR = 1.34; 95% CI, 1.09-1.66), lobular inflammation (HR = 1.3; 95% CI, 1.02-1.66) and NAFLD activity score (HR = 1.13; 95% CI, 1.02-1.25).
During follow-up, 87 of the 357 patients with fibrosis stage 0 to 2 died, compared with 19 of the 39 patients with fibrosis stage 3 to 4 (P < .001).
“These results pose interesting questions regarding the pathophysiological interplay between NAFLD and [type 2 diabetes], and indicates that the level of steatosis only is relevant for predicting [type 2 diabetes] in patients where fibrosis has not yet progressed to higher stages.” – by Talitha Bennett
Disclosures: The researchers report no relevant financial disclosures.