(05-06-15) High Prevalence of Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus and Normal Plasma

High Prevalence of Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus and Normal Plasma Aminotransferase Levels.

Sanchez PP1, Bril F, Maximos M, Lomonaco R, Biernacki D, Orsak B, Subbarayan S, Webb A, Hecht J, Cusi K.
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Abstract
CONTEXT AND OBJECTIVE:
Nonalcoholic fatty liver disease (NAFLD) and its more severe form with steatohepatitis (NASH), are common in patients with T2DM. However, they are usually believed to affect largely those with elevated aminotransferases. The aim of this study was to determine the prevalence of NAFLD (by the gold-standard, liver magnetic resonance and spectroscopy or 1H-MRS) in patients with T2DM and normal aminotransferases, and to characterize their metabolic profile.
PARTICIPANTS:
and Methods. We recruited 103 patients with T2DM and normal plasma aminotransferases (age: 60±8 years, BMI: 33±5 kg/m2, A1c: 7.6±1.3%). We measured the following: i) liver triglyceride content by 1H-MRS; ii) systemic insulin sensitivity (homeostasis model assessment-insulin resistance); and iii) adipose tissue insulin resistance, both fasting (as the adipose tissue insulin resistance index: fasting plasma free fatty acids[FFA] x insulin) and during an OGTT (as the suppression of FFA).
RESULTS:
The prevalence of NAFLD and NASH were much higher than expected (50% and 56% of NAFLD patients, respectively). The prevalence of NAFLD was higher in obese compared with nonobese patients as well as with increasing body mass index (P=.001 for trend). Higher plasma A1c was associated with a greater prevalence of NAFLD and worse liver triglyceride accumulation (P= .01). Compared with nonobese patients without NAFLD, patients with NAFLD had severe systemic (liver/muscle) and, particularly, adipose tissue (fasting/postprandial) insulin resistance (all P<.01).
CONCLUSIONS:
The prevalence of NAFLD is much higher than previously believed in overweight/obese patients with T2DM and normal aminotransferases. Moreover, many are at increased risk of severe liver disease (NASH). Physicians should have a lower threshold for screening patients with T2DM for NAFLD/NASH.

Source: J Clin Endocrinol Metab. 2015 Apr 17:jc20151966. [Epub ahead of print]

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