Impact of Diabetes Mellitus and Insulin on Nonalcoholic Fatty Liver Disease in the Morbidly Obese

• Published in: Annals of hepatology Vol. 17; no. 4; pp. 585 - 591
• Main Authors: Strey, Claudia B.M, Carli, Luiz A. de, Pioner, Sérgio R, Fantinelli, Marciane, Gobbato, Sabrina S, Bassols, Guilherme F, Losekann, Alexandre, Coral, Gabriela P
• Format: Journal Article
• Language: English
• Published: Mexico Elsevier 01.07.2018
• Subjects: Adult; Bariatric surgery; Brazil - epidemiology; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Disease Progression; Female; Gastroenterology and Hepatology; Humans; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Male; Middle Aged; NASH; Non-alcoholic Fatty Liver Disease - diagnosis; Non-alcoholic Fatty Liver Disease - epidemiology; Obese patients; Obesity, Morbid - diagnosis; Obesity, Morbid - epidemiology; Prevalence; Prognosis; Retrospective Studies; Risk Factors; Severity of Illness Index; Steatosis; Brazil; NASH; Bariatric surgery; Obese patients; Steatosis
• ISSN: 1665-2681
• DOI: 10.5604/01.3001.0012.0922

AbstractIntroduction and aim. The prevalence of obesity, type 2 diabetes mellitus and non-alcoholic fatty liver disease are increasing. Type 2 diabetes mellitus may aggravate non-alcoholic fatty liver disease, increasing the risk of developing cirrhosis and hepatocellular carcinoma. This study aims to determine the effect of type 2 diabetes mellitus and insulin therapy on non-alcoholic fatty liver disease in the patients with morbid obesity. Material and methods. Clinical, anthropometric and laboratory data were analyzed together with intraoperative liver biopsies from morbidly obese patients undergoing bariatric surgery. Results. 219 patients with morbid obesity were evaluated. Systemic arterial hypertension (55.9% vs. 33.8%, p = 0.004) and dyslipidemia (67.1% vs. 39.0%, p < 0.001) were more prevalent in patients with diabetes when compared to patients without diabetes. In multivariate analysis, type 2 diabetes mellitus was an independent risk factor for severe steatosis (RR = 2.04, p = 0.023) and severe fibrosis (RR = 4.57, p = 0.013). Insulin therapy was significantly associated with non-alcoholic steatohepatitis (RR = 1.89, p = 0.001) and fibrosis (RR = 1.75, p = 0.050) when all patients were analysed, but when only patients with diabetes were analysed, insulin therapy was not associated with non-alcoholic steatohepatitis or fibrosis. Conclusion. Type 2 diabetes mellitus plays an important role in the progression of non-alcoholic fatty liver disease as an independent risk factor for severe fibrosis.