Increased severity of liver fat content and liver fibrosis in non-alcoholic fatty liver disease correlate with epicardial fat volume in type 2 diabetes: A prospective study
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To determine whether severity of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis quantitatively assessed in individuals with diabetes mellitus (DM)-2 correlate with increased coronary heart disease (CHD) risk using non-invasive markers.
We conducted a single-centre, prospective, cross-sectional study in 100 consecutive diabetic individuals without known CHD recruited between March 2013 and September 2014. History, physical examination, serum markers, cardiac computed tomography (CT), magnetic resonance (MR) imaging-estimated proton density fat fraction (PDFF) and MR elastography (MRE) were obtained for 95 participants. Written informed consent was provided. Institutional review board approved this study. Spearman rank correlation was performed to assess for correlations. Multiple linear regression model determined independent predictors of epicardial adipose tissue (EAT) volume.
A p value < 0.05 determined statistical significance. The EAT volume was higher in the NAFLD group, defined as MR-imaging PDFF ≥ 5 %, compared to the non-NAFLD group (126.5 ml (IQR 80.9) versus 85.4 ml (IQR 44.7), p=0.002). MR imaging-PDFF correlated with EAT (r=0.42, p < 0.0001). MR imaging-PDFF and liver fibrosis were independently associated with EAT.
Higher liver fat content and liver fibrosis may portend worse cardiovascular risk in diabetics.
• EAT volume is higher in diabetic individuals with NAFLD.
• Liver fat content is positively correlated with EAT.
• Liver fat content and liver fibrosis were independently associated with EAT.
• Higher liver fat content and fibrosis may adversely affect cardiovascular risk.
KeywordsNon-alcoholic fatty liver disease Liver fibrosis Magnetic resonance imaging Coronary disease Multidetector computed tomography
Coronary artery calcium
Coronary heart disease
Epicardial adipose tissue
Magnetic resonance elastography
Non-alcoholic fatty liver disease
Proton density fat fraction
This study has received funding by the following:
• American Gastroenterological Association (AGA) Foundation—Sucampo—ASP Designated Research Award in Geriatric Gastroenterology
• T. Franklin Williams Scholarship Award
• Atlantic Philanthropies, Inc
• The John A. Hartford Foundation
• The Association of Specialty Professors
• American Gastroenterological Association
• Grant K23-DK090303
• Grant R01-DK106419-01.
• National Institute of Environmental Health Sciences of the National Institutes of Health under Award Number P42ES010337
Compliance with ethical standards
The scientific guarantor of this publication is Rohit Loomba MD MHSc.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors has significant statistical expertise.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in the following:
Doycheva I, Cui J, Nguyen P, et al. Non-invasive screening of diabetics in primary care for NAFLD and advanced fibrosis by MRI and MRE. Aliment Pharmacol Ther. 2016;43(1):83-95.
• Cross-sectional study
• Performed at one institution
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