Original Article—Liver, Pancreas, and Biliary Tract

Journal of Gastroenterology

, Volume 48, Issue 4, pp 515-525

First online:

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

  • Toshihide ShimaAffiliated withDepartment of Gastroenterology and Hepatology, Saiseikai Suita Hospital
  • , Hirofumi UtoAffiliated withDigestive and Life-style Related Disease, Kagoshima University Graduate School of Medical and Dental Sciences
  • , Kohjiro UekiAffiliated withDiabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo
  • , Toshinari TakamuraAffiliated withDisease Control and Homeostasis, Kanazawa University Graduate School of Medical Science
  • , Yutaka KohgoAffiliated withGastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical College
  • , Sumio KawataAffiliated withGastroenterology, Yamagata University Faculty of Medicine
  • , Kohichiroh YasuiAffiliated withMolecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine
  • , Hyohun ParkAffiliated withDiabetes and Metabolic Diseases, Saiseikai Suita Hospital
  • , Naoto NakamuraAffiliated withEndocrinology and Metabolism, Kyoto Prefectural University of Medicine
    • , Tatsuaki NakatouAffiliated withDiabetes Center, Okayama Saiseikai General Hospital
    • , Nobuyoshi TanakaAffiliated withGastroenterology, Fukui-ken Saiseikai Hospital
    • , Atsushi UmemuraAffiliated withDepartment of Gastroenterology and Hepatology, Saiseikai Suita Hospital
    • , Masayuki MizunoAffiliated withDepartment of Gastroenterology and Hepatology, Saiseikai Suita Hospital
    • , Junko TanakaAffiliated withDepartment of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical Sciences
    • , Takeshi OkanoueAffiliated withDepartment of Gastroenterology and Hepatology, Saiseikai Suita Hospital Email author 

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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.


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.


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.


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.


Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Diabetes mellitus Hepatitis virus carrier Alcoholic liver disease Nationwide study