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Clinicopathological features of liver injury in patients with type 2 diabetes mellitus and comparative study of histologically proven nonalcoholic fatty liver diseases with or without type 2 diabetes mellitus

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Abstract

Background

The Japan Society of Diabetes Mellitus reported that the leading cause of death in patients with diabetes mellitus (DM) was chronic liver disease; however, there are limited studies investigating the cause of liver injury in these patients. Our study aimed to clarify the clinicopathological features of liver injury and the characteristics of nonalcoholic fatty liver disease (NAFLD) in DM patients.

Methods

In total, 5,642 DM patients and 365 histologically proven NAFLD patients were enrolled. Clinical and laboratory parameters and liver biopsy results were, respectively, recorded and analyzed for the two sets of patients.

Results

Positivity rates for Hepatitis B surface antigens (HBsAg) and anti-hepatitis C virus antibodies (anti-HCV Ab) were 1.7 and 5.1 %, respectively. The proportion of drinkers consuming 20–59 g and ≥60 g alcohol daily was 14.9 and 4.3 %, respectively. The percentage of DM patients with elevated serum alanine aminotransferase (ALT) levels (≥31 IU/L) was 28.6 %. Alcohol consumption had no significant effect on serum ALT levels. Seventy-two percent of HBsAg-positive patients were serum hepatitis B virus (HBV)-DNA negative, whereas 10 % exhibited high levels of the same (>4.0 log copies/ml). Thirty-eight percent of anti-HCV Ab-positive patients were serum HCV-RNA negative. Among the NAFLD patients, the frequencies of NASH and advanced stage NASH were significantly higher in male DM patients than in male patients without DM.

Conclusions

Although HBsAg- and anti-HCV Ab-positivity rates were high in our Japanese DM patients, a majority of liver injuries could be associated with NAFLD/nonalcoholic steatohepatitis.

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Abbreviations

HCC:

Hepatocellular carcinoma

NAFLD:

Nonalcoholic fatty liver disease

DM:

Diabetes mellitus

NASH:

Nonalcoholic steatohepatitis

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

GGT:

Gamma glutamyl transpeptidase

FPG:

Fasting plasma glucose

HOMA-IR:

The homeostasis model assessment of insulin resistance index

HBsAg:

Hepatitis B surface antigen

anti-HBc Ab:

Anti-hepatitis B core antibody

anti-HCV Ab:

Anti-hepatitis C virus antibody

HBV-DNA:

Hepatitis B virus-deoxyribonucleic acid

HCV-RNA:

Hepatitis C virus-ribonucleic acid

OR:

Odds ratio

CI:

Confidence interval

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Acknowledgments

This work was supported by a Grant-in-Aid from the Ministry of Health, Labour and Welfare, Japan (T. O., H20-Hepatitis-general-008).

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

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Correspondence to Takeshi Okanoue.

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Shima, T., Uto, H., Ueki, K. et al. Clinicopathological features of liver injury in patients with type 2 diabetes mellitus and comparative study of histologically proven nonalcoholic fatty liver diseases with or without type 2 diabetes mellitus. J Gastroenterol 48, 515–525 (2013). https://doi.org/10.1007/s00535-012-0653-5

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  • DOI: https://doi.org/10.1007/s00535-012-0653-5

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