Article
The Relationship Between Glycaemic Control and Non-Alcoholic Fatty Liver Disease in Nigerian Type 2 Diabetic Patients

https://doi.org/10.1016/j.jnma.2017.06.001Get rights and content

Abstract

Background

Metabolic risk factors associated with non-alcoholic fatty liver disease (NAFLD) include Type 2 diabetes mellitus (T2DM), obesity and dyslipidaemia. Prevention or management of these risk factors with glycaemic control, weight reduction and low serum lipid levels respectively have been reported to reduce the risk of NAFLD or slow its progression. Since ultrasound (USS) is a safe and reliable method of identifying fatty changes in the liver, this study was done to determine the relationship between glycaemic control and ultrasound diagnosed NAFLD in T2DM.

Methodology

: Demographic data, anthropometric measurements and laboratory tests including glycated haemoglobin (HbA1c), fasting blood glucose (FBG) and serum lipids of 80 T2DM subjects aged 40-80 years were taken. Their livers were evaluated using B-mode ultrasound, and the data obtained were statistically analysed using SPSS version 20.

Results

Fifty-five of all participants (68.8%) were diagnosed with NAFLD sonographic grades 1, 2 and 3 made up of 13 (16.3%), 26 (32.5%) and 16 (20.0%), respectively while 25 (37.2%) had grade 0. The prevalence of NAFLD in T2DM varied significantly with BMI (p = 0.001) and glycaemic control (p = 0.048) while the USS grades of NAFLD varied significantly with age (p = 0.043) and BMI (p = 0.006). The independent strong predictors of NAFLD were overweight (r = 0.409, p = 0.012, OR = 6.626) and obesity (r = 0.411 p = 0.009, OR = 11.508), while poor glycaemic control (r = 0.270, p = 0.015, OR = 3.473) was a moderate independent predictor.

Conclusion

The prevalence of NAFLD increases with increasing BMI and HBA1c in T2DM, while its ultrasound grade varies with BMI. Overweight, obesity and poor glycaemic control are independent predictors of NAFLD.

Introduction

About 347 million people worldwide have been diagnosed with diabetes mellitus (DM), while the World Health Organization (WHO) projects that it will be the seventh leading cause of death by 2030.1 It is a metabolic disorder characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action or both.1 High insulin resistance and/or deficit in insulin secretion that is associated with DM increases the activity of the enzyme lipase.2 This gradual development of impairment in free fatty acid (FFA) metabolism leads to increased levels of FFA in excess of what the liver can oxidize. These are consequently deposited in the liver, a condition known as non-alcoholic fatty liver disease (NAFLD). Simple NAFLD can become non-alcoholic steatohepatitis when the liver cells get inflamed, progressing into fibrosis and eventually cirrhosis and/or hepatocellular carcinoma. Eventually, this greatly impairs the quality of life of a diabetic, culminating in end stage liver disease. Therefore, early detection and prompt management of NAFLD can greatly improve the quality of life of diabetics.3

Liver biopsy is the gold standard for diagnosing NAFLD but this method is invasive and cannot be used for screening purposes.4 Ultrasound (USS) has been shown to be sensitive in detecting fatty liver, and since it is safe, available, affordable, and does not require the use of ionizing radiation, it is the preferred method of choice for screening patients for NAFLD.5 Computerized Tomography (CT), Magnetic Resonance Imaging (MRI) and Spectroscopy are other alternative imaging techniques for the detection of fatty liver. They have however failed to show better accuracy than ultrasonography,5 and their high cost and other disadvantages such as radiation in CT and claustrophobic effects in MRI, limit their usefulness as screening tools.5

NAFLD in T2DM subjects has been well studied among Asians, Indians and Caucasians.4, 6, 7, 8, 9, 10, 11 However, the few African studies on the subject matter majorly addressed its prevalence and some associated risk factors.12, 13 The present study aimed to determine the relationship between NAFLD and glycaemic control levels in Nigerian T2DM subjects.

Section snippets

Recruitment of study subjects

The study was approved by the Review Board of our institution and written informed consent was obtained from all study participants. Eighty consecutive T2DM patients aged 40-80 years old without history of significant alcohol intake (less than 20 g/day for females and 30 g/day for males14) were recruited from the Endocrinology clinic of the hospital. The sample size was calculated by Leslie formula (with 10% attrition rate factored in) using a reported prevalence rate of 4.7% in T2DM in a

Results and discussion

The demographics of the 80 participants with T2DM recruited are given in Table 1. On the average, the participants had a mean age of 60.9 ± 1.15 years, an overweight BMI, a diabetic FBG, high HbA1c and a normal liver span (Table 2). The prevalence of fatty liver was not significantly different (p = 0.852) between the male and female subjects (Table 3).

The FBG level was not significantly different (p = 0.291) between diabetics with NAFLD and those without. Also, the prevalence of NAFLD was not

Implications

NAFLD impairs the quality of life of a diabetic, and can lead to end stage liver disease. Early detection and prompt management of NAFLD can greatly improve the quality of life of diabetics. Knowing the effect of glycaemic control on NAFLD will help the clinicians make better decisions on management of their diabetic patients. This article helps gastroenterologists, endocrinologist, nutritionists and public health authorities.

Acknowledgements

No funding closures.

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    Conflicts of interest: The authors declare no conflicts of interest to disclose.

    1

    Poster address: Department of Radiology, OAU Teaching Hospitals Complex, PMB 5538, Ile Ife, Osun State, Nigeria.

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