Influencing factors for nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus

Shunxiao ZHANG; Sheng ZHANG; Yan ZHANG; Yuanyuan LI; Yue CHEN; Mingyu SUN

doi:10.3969/j.issn.1001-5256.2023.05.013

Volume 39 Issue 5

May 2023

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Article Navigation > Journal of Clinical Hepatology > 2023 > 39(5): 1081-1088

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Influencing factors for nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus

DOI: 10.3969/j.issn.1001-5256.2023.05.013

Shunxiao ZHANG¹,
Sheng ZHANG¹,
Yan ZHANG¹,
Yuanyuan LI¹,
Yue CHEN^{1
,
,
,},
Mingyu SUN^{2, 3
,
,
,}

1.
Department of Endocrinology, Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 201999, China
2.
Key Laboratory of Liver and Kidney Diseases, Ministry of Education, Institute of Liver Diseases, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
3.
Second Department of Hepatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China

Research funding:

Key Research & Development of Shandong Province (2021CXGC010509);

Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Key Disciplines of Liver and Gall Bladder Diseases, and Key Laboratory of Chronic Deficiency Liver Disease of the State Administration of Traditional Chinese Medicine of the People's Republic of China (20DZ2272200);

Shanghai Key Clinical Specialty Construction Project (shslczdzk01201);

Shanghai Baoshan District Science and Technology Commission (21-E-62)

More Information

Corresponding author: CHEN Yue, 13701994461@163.com (ORCID: 0000-0003-3398-9516); SUN Mingyu, mysun248@hotmail.com (ORCID: 0000-0001-8103-7283)
Received Date: 2022-10-01
Accepted Date: 2022-11-28
Published Date: 2023-05-20

Abstract

Abstract

Objective To investigate related influencing factors in patients with type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD). Methods A total of 252 patients with T2DM who were treated in Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine from May 2021 to March 2022 were enrolled as subjects, and these patients were also included in Metabolic Management Center of China. According to the presence or absence of fatty liver disease, the patients were divided into simple T2DM group (n=105) and T2DM+NAFLD group (n=147). Related general data were analyzed, including sex, age, blood pressure, body height, body weight, neck circumference, triglyceride (TG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, fasting blood glucose, glycosylated hemoglobin, high-sensitivity C-reactive protein, albumin/creatinine ratio in morning urine, thyroid stimulating hormone, uric acid, intrahepatic fat deposition, carotid intima-media thickness, and brachial-ankle pulse wave velocity. The group t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was used to investigate the risk factors for T2DM with NAFLD, and the receiver operating characteristic (ROC) curve was used to assess the predictive value of related influencing factors. Results The age-stratified analysis showed that in the < 50 years age group, compared with the patients with T2DM alone, the patients with T2DM and NAFLD had significantly higher levels of body mass index (BMI), visceral fat, TG, brachial-ankle pulse wave velocity, albumin/creatinine ratio in morning urine, and uric acid (P < 0.05); in the ≥50 years age group, compared with the patients with T2DM alone, the patients with T2DM and NAFLD had significantly higher levels of blood pressure, BMI, visceral fat, TG, brachial-ankle pulse wave velocity, albumin/creatinine ratio in morning urine, and uric acid (P < 0.05) and a significantly lower level of serum HDL-C (P < 0.05). The multivariate logistic regression analysis showed that BMI (odds ratio [OR]=1.408, 95% confidence interval [CI]: 1.136-1.746, P=0.002), HDL-C (OR=0.031, 95% CI: 0.001-0.647, P=0.025), left brachial-ankle pulse wave velocity (OR=1.003, 95% CI: 1.001-1.006, P=0.003), and uric acid (OR=1.011, 95% CI: 1.005-1.016, P < 0.001) were independent influencing factors for T2DM with NAFLD. The ROC curve analysis showed that HDL-C, BMI, left brachial-ankle pulse wave velocity, and uric acid had an area under the ROC curve of 0.695 (95% CI: 0.574-0.812), 0.708 (95% CI: 0.628-0.788), 0.611 (95% CI: 0.523-0.698), and 0.698 (95% CI: 0.617-0.779), respectively, in evaluating T2DM with NAFLD. Conclusion Low levels of HDL-C, BMI, left brachial-ankle pulse wave velocity, and uric acid have a certain value in predicting NAFLD in patients with T2DM.
- Non-alcoholic Fatty Liver Disease,
- Diabetes Mellitus, Type 2,
- Risk Factors

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References

[1]	International Diabetes Federation. IDF Diabetes Atlas 10th edition[EB/OL]. (2021-11-08)[2022-08-16]. https://diabetesatlas.org/data/en/world/.
[2]	Chinese Society of Endocrinology, Chinese Medical Association. Consensus for diagnosis and treatment of nonalcoholic fatty liver diseases and metabolic disorders (2nd Edition)[J]. J Clin Hepatol, 2018, 34(10): 2103-2108. DOI: 10.3969/j.issn.1001-5256.2018.10.010. 中华医学会内分泌学分会. 非酒精性脂肪性肝病与相关代谢紊乱诊疗共识(第二版)[J]. 临床肝胆病杂志, 2018, 34(10): 2103-2108. DOI: 10.3969/j.issn.1001-5256.2018.10.010.
[3]	ZHOU Q, WANG Y, WANG J, et al. Prevalence and risk factor analysis for the nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus[J]. Medicine (Baltimore), 2021, 100(10): e24940. DOI: 10.1097/MD.0000000000024940.
[4]	SONG T, JIA Y, LI Z, et al. Effects of liraglutide on nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: a systematic review and meta-analysis[J]. Diabetes Ther, 2021, 12(6): 1735-1749. DOI: 10.1007/s13300-021-01072-4.
[5]	YOUNOSSI ZM, GOLABI P, de AVILA L, et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis[J]. J Hepatol, 2019, 71(4): 793-801. DOI: 10.1016/j.jhep.2019.06.021.
[6]	Chinese Society of Diabetes, Chinese Medical Association. Guidelines for the prevention and control of type 2 diabetes in China (2017 Edition)[J]. Chin J Diabetes Mellitus, 2018, 10(1): 4-67. DOI: 10.3760/cma.j.issn.1674-5809.2018.01.003. 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中华糖尿病杂志, 2018, 10(1): 4-67. DOI: 10.3760/cma.j.issn.1674-5809.2018.01.003.
[7]	National Workshop on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology, Chinese Medical Association; Fatty Liver Expert Committee, Chinese Medical Doctor Association. Guidelines of prevention and treatment for nonalcoholic fatty liver disease: A 2018 update[J]. J Clin Hepatol, 2018, 34(5): 947-957. DOI: 10.3969/j.issn.1001-5256.2018.05.007. 中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会. 非酒精性脂肪性肝病防治指南(2018年更新版)[J]. 临床肝胆病杂志, 2018, 34(5): 947-957. DOI: 10.3969/j.issn.1001-5256.2018.05.007.
[8]	WANG L, PENG W, ZHAO Z, et al. Prevalence and treatment of diabetes in China, 2013-2018[J]. JAMA, 2021, 326(24): 2498-2506. DOI: 10.1001/jama.2021.22208.
[9]	NAN Y, AN J, BAO J, et al. The Chinese Society of Hepatology position statement on the redefinition of fatty liver disease[J]. J Hepatol, 2021, 75(2): 454-461. DOI: 10.1016/j.jhep.2021.05.003.
[10]	BUZZETTI E, PINZANI M, TSOCHATZIS EA. The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD)[J]. Metabolism, 2016, 65(8): 1038-1048. DOI: 10.1016/j.metabol.2015.12.012.
[11]	TARGHER G, COREY KE, BYRNE CD, et al. The complex link between NAFLD and type 2 diabetes mellitus-mechanisms and treatments[J]. Nat Rev Gastroenterol Hepatol, 2021, 18(9): 599-612. DOI: 10.1038/s41575-021-00448-y.
[12]	ZHANG M, CHEN L, QU MD, et al. Analysis of the risk factors for NAFLD in patients with T2DM[J]. Parenter Enteral Nutr, 2019, 26(5): 271-275. DOI: 10.16151/j.1007-810x.2019.05.004. 张敏, 陈璐, 瞿美娣, 等. 2型糖尿病病人合并非酒精性脂肪性肝病的危险因素分析[J]. 肠外与肠内营养, 2019, 26(5): 271-275. DOI: 10.16151/j.1007-810x.2019.05.004.
[13]	MA HL, QUAN L, JIANG S. Analysis of clinical characteristics and risk factors in patients with nonal-coholic fatty liver disease complicated with type 2 diabetes mellitus[J]. China Med Herald, 2022, 19(21): 70-73, 82. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202221016.htm 马海林, 权莉, 蒋升. 非酒精性脂肪性肝病合并2型糖尿病患者的临床特征及危险因素分析[J]. 中国医药导报, 2022, 19(21): 70-73, 82. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202221016.htm
[14]	MANGLA N, AJMERA VH, CAUSSY C, et al. Liver stiffness severity is associated with increased cardiovascular risk in patients with type 2 diabetes[J]. Clin Gastroenterol Hepatol, 2020, 18(3): 744-746. DOI: 10.1016/j.cgh.2019.05.003.
[15]	MUZICA CM, SFARTI C, TRIFAN A, et al. Nonalcoholic fatty liver disease and type 2 diabetes mellitus: a bidirectional relationship[J]. Can J Gastroenterol Hepatol, 2020, 2020: 6638306. DOI: 10.1155/2020/6638306.
[16]	ALEMANY-PAGÈS M, MOURA-RAMOS M, ARAÚJO S, et al. Insights from qualitative research on NAFLD awareness with a cohort of T2DM patients: time to go public with insulin resistance?[J]. BMC Public Health, 2020, 20(1): 1142. DOI: 10.1186/s12889-020-09249-5.
[17]	VUSIRIKALA A, THOMAS T, BHALA N, et al. Impact of obesity and metabolic health status in the development of non-alcoholic fatty liver disease (NAFLD): A United Kingdom population-based cohort study using the health improvement network (THIN)[J]. BMC Endocr Disord, 2020, 20(1): 96. DOI: 10.1186/s12902-020-00582-9.
[18]	AMPUERO J, RANCHAL I, GALLEGO-DURÁN R, et al. Oxidized low-density lipoprotein antibodies/high-density lipoprotein cholesterol ratio is linked to advanced non-alcoholic fatty liver disease lean patients[J]. J Gastroenterol Hepatol, 2016, 31(9): 1611-1618. DOI: 10.1111/jgh.13335.
[19]	ALONSO-DOMÍNGUEZ R, SÁNCHEZ-AGUADERO N, PATINO-ALONSO MC, et al. Association between measurements of arterial stiffness and target organ damage in a general Spanish population[J]. Ann Med, 2021, 53(1): 345-356. DOI: 10.1080/07853890.2021.1881812.
[20]	CAUSSY C, AUBIN A, LOOMBA R. The relationship between type 2 diabetes, NAFLD, and cardiovascular risk[J]. Curr Diab Rep, 2021, 21(5): 15. DOI: 10.1007/s11892-021-01383-7.
[21]	American Diabetes Association Professional Practice Committee. Addendum. 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022;45(Suppl. 1): S144-S174[J]. Diabetes Care, 2022, 45(9): 2178-2181. DOI: 10.2337/dc22-ad08.
[22]	CUI Y, LIU J, SHI H, et al. Serum uric acid is positively associated with the prevalence of nonalcoholic fatty liver in non-obese type 2 diabetes patients in a Chinese population[J]. J Diabetes Complications, 2021, 35(5): 107874. DOI: 10.1016/j.jdiacomp.2021.107874.
[23]	HE J, YE J, SUN Y, et al. The additive values of the classification of higher serum uric acid levels as a diagnostic criteria for metabolic-associated fatty liver disease[J]. Nutrients, 2022, 14(17): 3587. DOI: 10.3390/nu14173587.

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Influencing factors for nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus

DOI: 10.3969/j.issn.1001-5256.2023.05.013

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