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
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.
KeywordsNonalcoholic fatty liver disease Nonalcoholic steatohepatitis Diabetes mellitus Hepatitis virus carrier Alcoholic liver disease Nationwide study
Nonalcoholic fatty liver disease
Hepatitis B virus
Hepatitis C virus
Gamma glutamyl transpeptidase
Fasting plasma glucose
The homeostasis model assessment of insulin resistance index
Hepatitis B surface antigen
- anti-HBc Ab
Anti-hepatitis B core antibody
- anti-HCV Ab
Anti-hepatitis C virus antibody
Hepatitis B virus-deoxyribonucleic acid
Hepatitis C virus-ribonucleic acid
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.
- 1.International Diabetes Federation. IDF Diabetes Atlas (article online). 5th ed. International Diabetes Federation: Brussels; 2011. www.idf.org/diabetesatlas. Accessed 6 May 2012.
- 4.Hotta N, Nakamura J, Iwamoto Y, Ohno Y, Kasuga M, Kikkawa R, et al. Causes of death in Japanese diabetics based on the results of a survey of 18,385 diabetics during 1991–2000—report of committee on cause of death in diabetes mellitus. J Jpn Diab Soc. 2007;50:47–61.Google Scholar
- 5.The Ministry of Health, Labour and Welfare, Japan. Annual change in causes of death among Japanese patients who died of malignancy. www.mhlw.go.jp/toukei/saikin/hw/jinkou/suii05/deth16.html. Accessed 8 July 2012.
- 6.The Ministry of Health, Labour and Welfare, Japan.Causes of death in Japan. Available from www.mhlw.go.jp/toukei/saikin/hw/jinkou/kakutei05/hyo6.html.Accessed 8July 2012.
- 22.Tokushige K, Hashimoto E, Horie Y, Taniai M, Higuchi S. Hepatocellular carcinoma in Japanese patients with nonalcoholic fatty liver disease, alcoholic liver disease, and chronic liver disease of unknown etiology: report of the nationwide survey. J Gastroenterol. 2011;46:1230–7.PubMedCrossRefGoogle Scholar