Study of Non-Alcoholic Fatty Liver Disease and Its Association with Coronary Artery Disease
DOI:
https://doi.org/10.70284/njirm.v9i2.2320Keywords:
Fatty liver, diabetes mellitus, coronary artery diseaseAbstract
Introduction: Non-alcoholic fatty liver disease (NAFLD) is a type of fatty liver which occurs when fat is deposited in the liver due to causes other than excessive alcohol use. Data suggests that NAFLD is also an independent risk factor of cardiovascular disease, which remains the commonest cause of mortality in such patients.
Aims: This study was conducted to estimate the prevalence of NAFLD diagnosed by ultrasound examination of the liver in type 2 diabetes mellitus (DM) and to assess the association between NAFLD and coronary artery disease (CAD) in type 2 DM. Settings and Design: This is an observational study conducted at Department of General Medicine of a tertiary care centre for 2 years. Methods: 500 adult patients (age >18 years) of type 2 DM were evaluated for NAFLD, CAD and other cardiovascular risk factors. Statistical analysis used: Microsoft Excel® and SPSS® 20 for Windows® were used for data storage and analysis. Results: The incidence of NAFLD was 44% in all diabetics, among them males were affected more (50%) than females (40%). Mean BMI was 27.8 and 27.2 among males and females respectively. NAFLD subjects had higher incidence of smoking, hypertension, obesity, dyslipidemia, uncontrolled sugar and CAD than Non-NAFLD group subjects. These differences were statistically significant. Conclusions: Clinicians should look for NAFLD in diabetics, especially in the presence of the metabolic syndrome. Once found, aggressive management of risk factors for CAD should be the primary goal, given the greater odds of developing CAD and the high prevalence of CAD in diabetics with NAFLD.
References
2. Rinella ME. "Nonalcoholic fatty liver disease: a systematic review". JAMA (Systematic review) 2015;313:2263–73.
3. Adams LA, Angulo P. "Treatment of nonâ€alcoholic fatty liver disease". Postgrad Med J 2006;82:315–22.
4. Sanyal A J. "AGA Technical Review on Nonalcoholic Fatty Liver Disease. Gastroenterology 2002;123:1705-25.
5. Clark JM, Diehl AM. "Nonalcoholic fatty liver disease: an underrecognized cause of cryptogenic cirrhosis." JAMA 2003;289:3000–4.
6. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 2011;34:274–85.
7. Bellentani S, Saccoccio G, Masutti F, Crocè LS, Brandi G, Sasso F, et al. Prevalence of and risk factors for hepatic steatosis in Northern Italy. Ann Intern Med 2000;132:112–7.
8. Wanless R, Lentz JS. Fatty liver hepatitis (steatohepatitis) and obesity: an autopsy study with analysis of risk factors. Hepatology 1990;12(5):1106-10.
9. Williamson RM, Price JF, Glancy S, Perry E, Nee LD, Hayes PC, et al. 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. Diabetes Care 2011;34(5):1139–44.
10. Machado M, Marques-Vidal P, Cortez-Pinto H. Hepatic histology in obese patients undergoing bariatric surgery. J Hepatol 2006;45:600-6.
11. Chang E, Park CY, Park SW. Role of thiazolidinediones, insulin sensitizers, in non-alcoholic fatty liver disease. J Diabetes Investig 2013;4:517-24.
12. Gaggini M, Morelli M, Buzzigoli E, DeFronzo RA, Bugianesi E, Gastaldelli A. Non-alcoholic fatty liver disease (NAFLD) and its connection with insulin resistance, dyslipidemia, atherosclerosis and coronary heart disease. Nutrients 2013;5:1544-60.
13. Brea A, Puzo J. Non-alcoholic fatty liver disease and cardiovascular risk. Int J Cardiol 2013;167:1109-17.
14. Attar BM, Van Thiel DH. Current concepts and management approaches in nonalcoholic fatty liver disease. Sci World J 2013;2013:481-893.
15. Wong VW, Wong GL, Yip GW, Lo AO, Limquiaco J, Chu WC, et al. Coronary artery disease and cardiovascular outcomes in patients with non-alcoholic fatty liver disease. Gut 2011;60:1721–7.
16. Arslan U, Turkoğlu S, Balcıoğlu S, Tavıl Y, Karakan T, Cengel A. Association between nonalcoholic fatty liver disease and coronary artery disease. Coron Artery Dis 2007;18:433-6.
17. Ndumele CE, Nasir K, Conceiçao RD, Carvalho JAM, Blumenthal RS, Santos RD. Hepatic steatosis, obesity, and the metabolic syndrome are independently and additively associated with increased systemic inflammation. Arterioscler Thromb Vasc Biol 2011;31:1927-32.
18. Verrijken A, Francque S, Mertens I, Prawitt J, Caron S, Hubens G, et al. Prothrombotic factors in histologically proven NAFLD and NASH. Hepatology 2013;59:121-29.
19. Stanković MN, Mladenović DR, DuriÄić I, Å obajić SS, Timić J, JorgaÄević B, et al. Time-dependent changes and association between liver free fatty acids, serum lipid profile and histological features in mice model of nonalcoholic fatty liver disease. Arch Med Res 2014;45:116-24.
20. Edens EA, Kuipers F, Stolk RP. Non-alcoholic fatty liver disease is associated with cardiovascular disease risk markers. Obes Rev 2009;10:412-9.
21. Puchner SB, Lu MT, Mayrhofer T, Liu T, Pursnani A, Ghoshhajra BB, et al. High-risk coronary plaque at coronary CT angiography is associated with nonalcoholic fatty liver disease, independent of coronary plaque and Stenosis Burden: results from the ROMICAT II trial. Radiology 2015;274:693-701.
22. Ekstedt M, Hagström H, Nasr P, Fredrikson M, Stål P, Kechagias S, et al. Fibrosis stage is the strongest predictor for disease-specificmortality in NAFLD after up to 33 years of follow-up. Hepatology 2014;61:1547-54.
23. Perazzo H, Munteanu M, Ngo Y, Lebray P, Seurat N, Rutka F, et al. Prognostic value of liver fibrosis and steatosis biomarkers in type-2 diabetes and dyslipidaemia. Aliment Pharmacol Ther 2014;40:1081-93.
