Prevalence of and Risk Factors for Hepatic Steatosis and Nonalcoholic Fatty Liver Disease in People With Type 2 Diabetes: the Edinburgh Type 2 Diabetes Study

• Published in: Diabetes care Vol. 34; no. 5; pp. 1139 - 1144
• Main Authors: Williamson, Rachel M, Price, Jackie F, Glancy, Stephen, Perry, Elisa, Nee, Lisa D, Hayes, Peter C, Frier, Brian M, Van Look, Liesbeth A.F, Johnston, Geoffrey I, Reynolds, Rebecca M, Strachan, Mark W.J
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.05.2011
• Subjects: Aged; alcohols; autoantibodies; Biological and medical sciences; body mass index; Care and treatment; Clinics; Complications and side effects; Diabetes; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - physiopathology; Diabetes. Impaired glucose tolerance; Diagnosis; drug therapy; elderly; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Fatty liver; Fatty Liver - diagnosis; Fatty Liver - epidemiology; Female; ferritin; fibrosis; hepatitis; hepatotoxicity; Humans; liver; Liver cirrhosis; Liver diseases; Male; Medical sciences; Metabolic diseases; metabolic syndrome; metformin; Middle Aged; Miscellaneous; Non-alcoholic Fatty Liver Disease; noninsulin-dependent diabetes mellitus; Older people; Original Research; people; Prevalence studies (Epidemiology); Public health. Hygiene; Public health. Hygiene-occupational medicine; questionnaires; regression analysis; Risk Factors; screening; spectroscopy; triacylglycerols; Type 2 diabetes; ultrasonics; ultrasonography; United Kingdom; Endocrinopathy; Type 2 diabetes; Human; Prevalence; Nutrition; Hepatic disease; Metabolic diseases; Epidemiology; Fatty liver; Non alcoholic steatohepatitis; Risk factor; Digestive diseases; Endocrinology
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc10-2229

OBJECTIVE: Type 2 diabetes is an established risk factor for development of hepatic steatosis and nonalcoholic fatty liver disease (NAFLD). We aimed to determine the prevalence and clinical correlates of these conditions in a large cohort of people with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 939 participants, aged 61-76 years, from the Edinburgh Type 2 Diabetes Study (ET2DS)--a large, randomly selected population of people with type 2 diabetes--underwent liver ultrasonography. Ultrasound gradings of steatosis were compared with magnetic resonance spectroscopy in a subgroup. NAFLD was defined as hepatic steatosis in the absence of a secondary cause (screened by questionnaire assessing alcohol and hepatotoxic medication use, plasma hepatitis serology, autoantibodies and ferritin, and record linkage to determine prior diagnoses of liver disease). Binary logistic regression was used to analyze independent associations of characteristics with NAFLD. RESULTS: Hepatic steatosis was present in 56.9% of participants. After excluding those with a secondary cause for steatosis, the prevalence of NAFLD in the study population was 42.6%. Independent predictors of NAFLD were BMI, lesser duration of diabetes, HbA₁c, triglycerides, and metformin use. These remained unchanged after exclusion of participants with evidence of hepatic fibrosis from the group with no hepatic steatosis. CONCLUSIONS: Prevalences of hepatic steatosis and NAFLD were high in this unselected population of older people with type 2 diabetes, but lower than in studies in which ultrasound gradings were not compared with a gold standard. Associations with features of the metabolic syndrome could be used to target screening for this condition.