Shivaram Prasad Singh^1*, Ayaskanta Singh¹, Girish Kumar Pati¹, Bijay Misra¹, Debasis Misra¹, Sanjib Kumar Kar¹, Manas Kumar Panigrahi¹, Chudamani Meher², Omprakash Agrawal², Niranjan Rout³, Kaumudi Pattnaik⁴, Pallavi Bhuyan⁴, Amarendra Mohapatra⁵

Show more
¹ Department of Gastroenterology, S. C. B. Medical College, Cuttack, India.
² Department of Radiology, Beam Diagnostics Centre, Cuttack, India.
³ Department of Oncopathology, A. H. Regional Cancer Center, Cuttack, India.
⁴ Department of Pathology, S. C. B. Medical College, Cuttack, India.
⁵ Regional Medical Research Centre, Bhubaneswar, India.
Show less

Abstract: Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is more common in diabetic patients. There are limited studies on clinical, biochemical and histological features of NAFLD patients who are diabetic. The aim of the study was to determine the prevalence of diabetes and prediabetes in a cohort of NAFLD patients and to compare anthropometry, biochemical and metabolic parameters and hepatic histology of diabetic NAFLD patients with non-diabetic NAFLD patients. Methods: 515 consecutive NAFLD patients diagnosed by abdominal ultrasound and 100 healthy controls were subjected to detailed anthropometric measurements and biochemical assays including blood sugars, LFT, lipid profile and HOMA. Diabetes and prediabetes were defined according to WHO criteria. Patients were categorized and compared according to the presence or absence of diabetes. Liver biopsy was performed in 240 NAFLD patients and the liver histology was also compared between the two groups. Statistical analysis was performed on SPSS 16. Results: 124 out of the 515 (24.08%) NAFLD patients were diabetics, 118 out of 515 (22.9%) were pre-diabetics, while only 3 out of 100 controls had impaired glucose tolerance. Diabetic patients were older. NAFLD patients with diabetes had significantly higher waist circumference [98.02 ± 12.01 vs 93.89 ± 8.8, p = 0.000] as compared to the NAFLD patients without diabetes. Fasting blood sugar [124 ± 46.3 vs 90.8 ± 10.2, p = 0.000], triglyceride level [218.4 ± 17.6 vs 192 ± 9, p = 0.03] and HOMA-IR [2.6 ± 0.36 vs 1.84 ± 0.2, p < 0.001] were significantly higher in NAFLD-diabetes group. Hypertension [35% vs 11.7%, p = 0.000] was commoner in diabetic NAFLD patients. Histopathology in the diabetic patients revealed steatosis alone in 34.2% cases, borderline NASH in 31.4% and definite NASH in 34.2%. Fatty change alone was noted in 16.5% cases, borderline NASH in 34.1%, while 49% had definite NASH on liver biopsy of NAFLD patients without diabetes. Fibrosis was noted in 31.4% in diabetic and 27% in non-diabetic patients. IR alone had a linear correlation with necroinflammatory activity. Conclusion: The prevalence of diabetes and prediabetes is six times more in NAFLD patients than in healthy controls. NAFLD patients with diabetes have higher metabolic risk factors such as large waistline, hypertension, high triglyceride levels and increased insulin resistance. Diabetes or pre diabetes patients per se do not have histologically severe disease, rather insulin resistance play an important role in increasing the severity of the disease.

Keywords: Fatty Liver, Diabetes, Prediabetes, Liver Histology, Insulin Resistance, Steatohepatitis

Cite this paper: Singh, S. , Singh, A. , Pati, G. , Misra, B. , Misra, D. , Kar, S. , Panigrahi, M. , Meher, C. , Agrawal, O. , Rout, N. , Pattnaik, K. , Bhuyan, P. and Mohapatra, A. (2014) A Study of Prevalence of Diabetes and Prediabetes in Patients of Non-Alcoholic Fatty Liver Disease and the Impact of Diabetes on Liver Histology in Coastal Eastern India. Journal of Diabetes Mellitus, 4, 290-296. doi: 10.4236/jdm.2014.44040.

References

[1]   Farrell, G.C. and Larter, C.Z. (2006) Nonalcoholic Fatty Liver Disease: From Steatosis to Cirrhosis. Hepatology, 43, S99-S112. http://dx.doi.org/10.1002/hep.20973

[2]   Bugianesi, E., Leone, N. and Vanni, E. (2002) Expanding the Natural History of Nonalcoholic Steatohepatitis: From Cryptogenic Cirrhosis to Hepatocellular Carcinoma. Gastroenterology, 123, 134-140. http://dx.doi.org/10.1053/gast.2002.34168

[3]   Singh, S.P., Nayak, S., Swain, M., Rout, N., Mallick, R.N., Agarwal, O., Meher, C. and Rao, M. (2004) Prevalence of Nonalcoholic Fatty Liver Disease in Coastal Eastern India: A Preliminary Ultrasonographic Survey. Tropical Gastroenterology, 25, 76-79.

[4]   Mohan, V., Farooq, S., Deepa, M., et al. (2009) Prevalence of Nonalcoholic Fatty Liver Disease in Urban South Indians in Relations to Different Grades of Glucose Intolerance and Metabolic Syndrome. Diabetes Research and Clinical Practice, 84, 84-91. http://dx.doi.org/10.1016/j.diabres.2008.11.039

[5]   Amarapurkar, D., Kamani, P., Patel, R., Gupte, P., Kumar, P., Agal, S., et al. (2007) Prevalence of Non-Alcoholic Fatty Liver Disease: Population Based Study. Annals of Hepatology, 6, 161-163.

[6]   Marchesini, G., Brizi, M., Bianchi, G., Tomassetti, S., Bugianesi, E., Lenzi, M., et al. (2001) Nonalcoholic Fatty Liver Disease, a Feature of the Metabolic Syndrome. Diabetes, 50, 1844-1850.
http://dx.doi.org/10.2337/diabetes.50.8.1844

[7]   Madan, K., Batra, Y., Gupta, S.D., Chander, B., Rajan, K.D., Tewatia, M.S., Panda, S.K. and Acharya, S.K. (2006) Nonalcoholic Fatty Liver Disease May Not Be a Severe Disease at Presentation among Asian Indians. World Journal of Gastroenterology, 12, 3400-3405.

[8]   Duseje, A., Das, A., Das, R., Dhiman, R.K., Chawla, A., Bhansali, A., et al. (2007) The Clinicopathological Profile of Indian Patients with Nonalcoholic Fatty Liver Disease (NAFLD) Is Different from That in the West. Digestive Diseases and Sciences, 52, 2368-2374. http://dx.doi.org/10.1007/s10620-006-9136-y

[9]   Angulo, P., Keach, J.C., Batts, K.P. and Lindor, K.D. (1999) Independent Predictors of Liver Fibrosis in Patients with Non-Alcoholic Steatohepatitis. Hepatology, 306, 1356-1362.
http://dx.doi.org/10.1002/hep.510300604

[10]   Dixon, J.B., Bhathal, P.S. and O’Brien, P.E. (2001) Nonalcoholic Fatty Liver Disease: Predictors of Nonalcoholic Steatohepatitis and Liver Fibrosis in the Severely Obese. Gastroenterology, 121, 91-100. http://dx.doi.org/10.1053/gast.2001.25540

[11]   Das, S., Singh, S.P., Parida, P.K. and Mallick, R.N. (2010) Non-Alcoholic Fatty Liver Disease in Subjects with Type 2 Diabetes Mellitus and Non-Diabetics with Special Reference to Insulin Resistance and Hepatic Histopathological Changes. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 4, 226-229. http://dx.doi.org/10.1016/j.dsx.2010.07.004

[12]   Matthews, D.R., Hosker, J.P., Rudenski, A.S., Naylor, B.A., Treacher, D.F. and Turner, R.C. (1985) Homeostasis Model Assessment: Insulin Resistance and Beta Cell Function from Fasting Plasma Glucose and Insulin Concentrations in Man. Diabetologia, 28, 412-419.
http://dx.doi.org/10.1007/BF00280883

[13]   Bonora, E., Targher, G., Alberiche, M., Bonadonna, R.C., Saggiani, F., Zenere, M.B., et al. (2000) Homeostasis Model Assessment Closely Mirrors the Glucose Clamp Technique in the Assessment of Insulin Sensitivity. Diabetes Care, 23, 57-63. http://dx.doi.org/10.2337/diacare.23.1.57

[14]   Das, S., Bhoi, S.K., Baliarsinha, A.K. and Baig, M.A.A. (2007) Auto Immunity, Insulin Resistance and Beta Cell Function in Subjects with Low Body Weight, Type 2 Diabetes Mellitus. Metabolic Syndrome and Related Disorders, 5, 136-141. http://dx.doi.org/10.1089/met.2006.0024

[15]   Kleiner, D.E., Brunt, E.M., Van Natta, M., Behling, C., Contos, J.M., Cummings, O., et al. (2005) Design and Validation of a Histological Scoring System for Nonalcoholic Fatty Liver Disease. Hepatology, 41, 1313-1321. http://dx.doi.org/10.1002/hep.20701

[16]   Wanless, I.R. and Lentz, J.S. (1990) Fatty Liver Hepatitis (Steatohepatitis) and Obesity: An Autopsy Study with Analysis of Risk Factors. Hepatology, 12, 1106-1110.
http://dx.doi.org/10.1002/hep.1840120505

[17]   Amarapurkar, D. and Das, H.S. (2002) Chronic Liver Disease in Diabetes Mellitus. Tropical Gastroenterology, 23, 3-5.