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Submitted: 09 January 2008 Modified: 03 July 2019
HERDIN Record #: PCHRD010808090154

The association of risk factors in the development of non-alcoholic fatty liver disease (NAFLD) in Filipino patients with type 2 diabetes mellitus in a tertiary center .

Jovie Joy Manuel,
Elaine Palugod,
Juliet Cervantes,
Mercy Go-Santi,
Joselynna Quimpo,
Gabriel Jasul

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BACKGROUND: Non-alcoholic Fatty Liver Disease (NAFLD) includes a spectrum of liver damage, ranging from simple, bland steatosis, which is usually associated with a benign prognosis, to nonalcoholic steatohepatitis (NASH), which has the potential to progress to cirrhosis and its inherent complications of liver failure and liver cancer. It is reported to be prevalent among patients with Type 2 Diabetes Mellitus.


OBJECTIVES: (1) To determine the association of the risk factors in the development of non-alcoholic fatty liver disease, in Filipino patients with Type 2 Diabetes Mellitus; (2) To assess the correlation between the severity of ultrasonographic hepatic steatosis and degree of glucose control, dyslipidemia and obesity; (3) To observe the hepatic markers particularly the transaminases in patients with Type 2 diabetes mellitus with obesity and or dyslipidemia.


METHODS: One hundred forty se-ven diagnosed Type 2 diabetes without history of alcohol intake >30g/week in men and 20g/week in women underwent history and physical examination and anthropometric measurements. BMI was used to estimate overall adiposity. Fasting blood samples were collected for measurement of liver function (GGT, ALT, AST, CHON, Bilimbin, ALP), and hepatitis profile (HBsAg, Anti-HBs, Anti-HCV) to note those with concurrent liver diseases. Lipid profile, were also obtained to identify diabetic patients with dyslipidemia; fasting blood sugar, and HbAlc defined the glycemic control in its relation to the presence of probable NAFLD. All subjects underwent ultrasonography of the liver using one ultrasound machine, performed by one radio-technologist, and read by only one sonologist. Presence of fatty liver was noted and reported as mild, moderate and severe.


RESULTS: Features of NAFLD seen in the subjects in this study include absence of symptoms referable to the liver, elevated transaminases ( ALT at 15 percent, AST at 13 percent, with ALT/AST > lat 12 percent) and with features of metabolic syndrome. Statistatically, there is no association of the ALT/ AST > 1 (probable NAFLD) among the Type 2 DM subjects with dyslipidemia, obesity and metabolic syndrome. Sonographic NAFLD, however, showed that there is a significant association of fatty liver and obesity at 69% with a p value of


CONCLUSION: There is a close link of hepatic steatosis to T2DM patients who are obese. Elevated ALT was correlated in the development of fatty liver. Type 2 Diabetes Mellitus associated with NAFLD has the potential to progress to cirrhosis and its inherent complications of liver failure and liver cancer and thus make an important endocrine health problem. (Author)

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Journal of Internal Medicine
Frequency
Six times a year (6x/year)
Publication Date
May-June 2007
Volume
45
Issue
3
Page(s)
135-143
LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Library Box No. 48 Fulltext Print Format (Request Document)
Philippine Council for Health Research and Development Fulltext pdf (Request Document)
1. Younossi, Z M, et al, . "Nonalcoholic fatty liver disease: An Agenda for clinical research" Hepatology 35, 746, 2002
2. Bugianesi, E , et al, . "Expanding the natural history on nonalcoholic steatohepatitis" Gastroenterology 123, 134, 2002
3. Anania, Frank . "Non-alcoholic fatty liver disease" Adv Stud Med 4(1): 23, 2004
4. Kelley, David E, et al, . "Fatty liver in type 2 diabetes mellitus: Relation to regional adiposity, fatty acids, and insulin resistance" American Journal Physiol Endocrinol Metab 285, E906 - E91, 2003
5. Silverman, J F, O, K F, Long, S , et al, . "Liver pathology in morbidity obese patients with and without diabetes" American Journal Gastroenterology 85, 1349, 1990
6. Adams, L , et al, . Nonalcoholic fatty liver disease, from the Division of Gastroenterology and Hepatology, Mayo Clinic and College of Medicine, Rochester, Minn, March 29, 2005.
7. Feldstein, Ariel E, et al, . Fatty liver disease, Posted American College of Gastroenterology, Cleveland, 2004.
8. Weston, Shioban , NAFLD, . The Not So Silent Epidemic, Winthrop University Hospital, September 16, 2005
9. Hanley, Anthony J.G., et al, . "Elevation in markers of liver injury and risk of type 2 diabetes: The Insulin resistance atherosclerosis study" Diabetes 53(10): 2623, 2004
10. Mc Gahan, John , Goldberg, Barry . Diagnostic Ultrasound. A Logical Approach Lipincott-Raven, 1998. 655.
11. Cua, Ian H. "Non-alcoholic fatty liver disease" Hospital Medicine 66(2): 106, 2005
12. Angulo, Paul . "Nonalcoholic fatty liver disease" The New England Journal of Medicine 346(16): 1221, 2002
13. Diabetes therapies show promise for treatment of non-alcoholic steatohepatitis. AASLD 53rd Annual Meeting: Abstracts 971, 2002,
14. Pratt, Janey S, et al, . "Case 25-2004 - A 49-year-old woman with severe obesity, diabetes, and hypertension" The New England Journal of Medicine 35(7): 696, 2004
15. Angulo, Paul . Nonalcoholic fatty liver disease - Diagnosistherapy, 55th Annual Meeting of the American Association for the study of liver diseases, posted. Medscape, 2004.
16. Sunyal, Arun . Nonalcoholic fatty liver disease. Clinical advances: Highlights of the American Gastroenterological Association 2001 Spring Postgraduate course. Part 1. posted Medscape, 2001.
17. Brunt, Elizabeth M. "Nonalcoholic steatohepatitis" Semin Liver Disease 24(1): 3 - 20, 2004
18. Harris, Elizabeth H. "Elevated liver function tests in type 2 diabetes" Clinical Diabetes 23, 115, 2005
19. William, M . Outlaw nonalcoholic fatty liver disease (NAFLD). Where are we twenty years later? December 2, 2003
20. Parisi, Giancarlo . Nonalcoholic steatohepatitis, 9th Meeting of the Mediterranean group for mediterranean group for the study of siabetes, April 28 - May 1, 2005 Nice. France,
21. Marchesini, Giulio , et al, . "Nonalcoholic fatty liver disease A feature of the metabolic syndrome" Diabetes 50, 1844, 2001
22. Adams, Leon A, et al, . "Nonalcoholic fatty liver disease" Canadian Medical Association Journals 172(7): March 2005
23. Foster, K J, et al, . "Liver disease in patients with diabetes mellitus" Postgraduate Medical Journal 56, 767, 1980
24. Regimbeau, Jean M, et al, . "Obesity and diabetes as risk factor for hepatocellular carcinoma. Liver transplantation" American Association for the Study of Liver Diseases 30 Jan 2004 10(S2): S69 - S73,