Abstract
Purpose
To evaluate the association between severity of hepatic steatosis/fibrosis with clinical, laboratory, and echocardiographic characteristics, including visceral obesity and type 2 diabetes mellitus (T2DM)-related micro- and macrovascular complications in diabetic patients with non-alcoholic fatty liver disease (NAFLD).
Methods
We studied 60 consecutive NAFLD outpatients with T2DM, recording several demographic and clinical characteristics, trunk and visceral fat, cardiac ultrasound, and micro- and macrovascular complications of diabetes mellitus including microalbuminuria, diabetic peripheral neuropathy, peripheral vascular disease, and cardiac autonomic function. Severity of steatosis and fibrosis was evaluated with abdominal ultrasound and liver stiffness measurements, respectively.
Results
Twenty-three (41%) of the patients had grade 1 steatosis and mean liver stiffness was 7.5 ± 3 kPa. After applying Bonferroni correction for multiple comparisons, ferritin concentration was the only factor significantly different between patients with mild (grade 1) compared to those with moderate/severe (grade 2/3) steatosis and showed good discriminative ability for the presence of moderate/severe steatosis (AUC: 0.74, sensitivity 88%, specificity 48%, PPV 74%, and NPV 72%). In addition, waist circumference was the only factor associated with the presence of significant fibrosis (≥ F2) with very good discriminative ability (AUC: 0.77, sensitivity 89%, specificity 45%, PPV 75%, and NPV 70%).
Conclusion
Specific clinical and laboratory characteristics, which may be determined via widely accessible and noninvasive techniques, were associated with severity of diabetics NAFLD, taking into account echocardiographic characteristics, visceral obesity, and T2DM-related systemic complications.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Code availability
Not applicable.
Abbreviations
- T2DM:
-
Type 2 diabetes mellitus
- NAFLD:
-
Non-alcoholic fatty liver disease
- OR:
-
Odds ratio
- C.I.:
-
Confidence intervals
- AUC:
-
Area under the curve
- HCC:
-
Hepatocellular carcinoma
- LT:
-
Liver transplantation
- MetS:
-
Metabolic syndrome
- BMI:
-
Body mass index
- AHT:
-
Arterial hypertension
- CVD:
-
Cardiovascular disease
- NCEP:
-
National Cholesterol Education Program
- ATP III:
-
Adult Treatment Panel III
- ALT:
-
Alanine aminotransferase
- AST:
-
Aspartate aminotransferase
- SAP:
-
Systolic arterial pressure
- WC:
-
Waist circumference
- PLT:
-
Platelets count
- ALT:
-
Alanine aminotransferase
- γ-GT:
-
γ-Glutamyl transpeptidase
- TC:
-
Total cholesterol
- TG:
-
Triglycerides
- HbA1c:
-
Glycosylated hemoglobin
- HDL:
-
High-density lipoprotein cholesterol
- LDL:
-
Low-density lipoprotein cholesterol
- HOMA-IR:
-
Homeostatic model assessment-insulin resistance
- ΒΙΑ:
-
Bioimpedance analysis
- NFS:
-
NAFLD fibrosis score
- LSM:
-
Liver stiffness measurements
- 2D-SWE:
-
Two-dimensional real-time shear wave elastography
- IVSD:
-
Interventricular septal thickness
- PWTd:
-
Posterior wall thickness
- EF:
-
Ejection fraction
- LVESD:
-
Left ventricular (LV) diameter at end-systole
- LVEDD:
-
LV end-diastole
- DT:
-
E-wave deceleration time
- IVRT:
-
Isovolumetric relaxation time
- LAD:
-
Left atrial diameter
- DD:
-
Diastolic dysfunction
- UACR:
-
Urine albumin-to-creatinine ratio
- DPN:
-
Diabetic peripheral neuropathy
- NSS:
-
Neuropathy Symptom Score
- NDS:
-
Neuropathy Disability Score
- VPT:
-
Vibration perception threshold
- PVD:
-
Peripheral vascular disease
- cfPWV:
-
Carotid-femoral pulse wave velocity
- CAN:
-
Cardiac autonomic function
- ABI:
-
Ankle-brachial index
- CAN:
-
Cardiac autonomic function
- LF:
-
Low-frequency
- HF:
-
High-frequency
- NNmean:
-
Mean normal-to-normal R-R interval length
- SDNN:
-
SD of all normal-to-normal R-R intervals
- ROC:
-
Receiver operating characteristic curve
- SGLT-2:
-
Sodium-glucose co-transporter-2
- GLP-1:
-
Glucagon-like peptide-1 (GLP1
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All authors equally contributed to this paper concerning conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version. All authors have equally contributed to the study conception and design.
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Cholongitas, E., Tsilingiris, D., Diamantopoulou, P. et al. Association of cardiovascular factors in diabetic patients with non-alcoholic fatty liver disease. Hormones 21, 133–145 (2022). https://doi.org/10.1007/s42000-021-00334-x
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DOI: https://doi.org/10.1007/s42000-021-00334-x