Frequency and Factors Associated with Non-Alcoholic Fatty Liver Disease in Patients with Diabetes Mellitus

Authors

  • Saeed Khan Department of Medicine, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
  • Shamimah Hanif Department of Medicine, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
  • Fazal ur Rahman Department of Medicine, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
  • Khushhal Khan Department of Medicine, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
  • Sobaidar Khan Department of Medicine, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
  • Sarfaraz Ahmed Department of Medicine, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
  • Syed Nadir Shah Department of Medicine, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i4.1039

Keywords:

Non-Alcoholic, Cardiovascular Disease, Kidney Disease, Diabetes Mellitus

Abstract

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is a major health concern globally, especially among individuals with Type 2 Diabetes Mellitus (T2DM). The coexistence of NAFLD and T2DM significantly increases the risk of liver fibrosis, cardiovascular disease, and chronic kidney disease, contributing to overall morbidity and mortality. Objective: This study aims to assess the frequency, risk factors, and complications associated with Non-Alcoholic Fatty Liver Disease among patients diagnosed with Type 2 Diabetes Mellitus in a tertiary care setting. Methods: 150 patients with Type 2 Diabetes Mellitus at tertiary care hospital Quetta participated in a qualitative study. Purposive sampling was utilised in the selection of participants. With an emphasis on clinical history, lifestyle factors, and comorbidities, information was acquired through semi-structured interviews and reviews of medical records. To examine the data, thematic analysis was used. Results: It was discovered that over 50% of patients had non-alcoholic fatty liver disease. Obesity, hypertension, dyslipidaemia, poor glycaemic management, and a sedentary lifestyle were the most prevalent risk factors. Among patients with NAFLD, cardiovascular and renal problems were also common. Conclusion: To guarantee early intervention and stop the development of serious consequences, screening for non-alcoholic fatty liver disease should be a regular component of managing type 2 diabetes mellitus.

Downloads

Download data is not yet available.

References

• Abbas, Z., & Zaheer, R. (2020). Non-alcoholic fatty liver disease: A real threat in Pakistan. Journal of the Pakistan Medical Association, 70(12), 2437-2440. https://doi.org/10.5455/jpma.95891

• Adams, L. A., Angulo, P., & Lindor, K. D. (2005). Nonalcoholic fatty liver disease. Cmaj, 172(7), 899-905. https://doi.org/10.1503/cmaj.045232

• Amarapurkar, D., Amarapurkar, A., Patel, N., Agal, S., Baigal, R., Gupte, P., & Pramanik, S. (2006). Nonalcoholic steatohepatitis (NASH) with diabetes: Predictors of liver fibrosis. Annals of Hepatology, 5(1), 30-33. https://doi.org/10.1016/s1665-2681(19)32036-8

• Angulo, P., Hui, J. M., Marchesini, G., Bugianesi, E., George, J., Farrell, G. C., Enders, F., Saksena, S., Burt, A. D., Bida, J. P., Lindor, K., Sanderson, S. O., Lenzi, M., Adams, L. A., Kench, J., Therneau, T. M., & Day, C. P. (2007). The NAFLD fibrosis score. Hepatology, 45(4), 846-854. https://doi.org/10.1002/hep.21496

• Armstrong, M. J., et al. (2016). Glucagon-like peptide 1 receptor agonists: A new therapeutic option for non-alcoholic fatty liver disease. Diabetes Care, 39(5), 698-706.

• Bedogni, G., Bellentani, S., Miglioli, L., Masutti, F., Passalacqua, M., Castiglione, A., & Tiribelli, C. (2006). The fatty liver index: A simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterology, 6(1). https://doi.org/10.1186/1471-230x-6-33

• Boursier, J., Mueller, O., Barret, M., Machado, M., Fizanne, L., Araujo‐Perez, F., Guy, C. D., Seed, P. C., Rawls, J. F., David, L. A., Hunault, G., Oberti, F., Calès, P., & Diehl, A. M. (2016). The severity of nonalcoholic fatty liver disease is associated with gut dysbiosis and shift in the metabolic function of the gut microbiota. Hepatology, 63(3), 764-775. https://doi.org/10.1002/hep.28356

• Bril, F., & Cusi, K. (2016). Nonalcoholic fatty liver disease: the new complication of type 2 diabetes mellitus. Endocrinology and Metabolism Clinics, 45(4), 765-781. https://www.endo.theclinics.com/article/S0889-8529(16)30063-9/abstract

• Bugianesi, E., Bellentani, S., Bedogni, G., & Tiribelli, C. (2008). Clinical update on non-alcoholic fatty liver disease and steatohepatitis. Annals of Hepatology, 7(2), 157-160. https://doi.org/10.1016/s1665-2681(19)31873-3

• Byrne, C. D., & Targher, G. (2015). NAFLD: A multisystem disease. Journal of Hepatology, 62(1), S47-S64. https://doi.org/10.1016/j.jhep.2014.12.012

• Chalasani, N., Younossi, Z., Lavine, J. E., Diehl, A. M., Brunt, E. M., Cusi, K., Charlton, M., & Sanyal, A. J. (2012). The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology, 55(6), 2005-2023. https://doi.org/10.1002/hep.25762

• Cusi, K. (2009). Role of insulin resistance and Lipotoxicity in non-alcoholic Steatohepatitis. Clinics in Liver Disease, 13(4), 545-563. https://doi.org/10.1016/j.cld.2009.07.009

• Francque, S. M., Van der Graaff, D., & Kwanten, W. J. (2016). Non-alcoholic fatty liver disease and cardiovascular risk: Pathophysiological mechanisms and implications. Journal of Hepatology, 65(2), 425-443. https://doi.org/10.1016/j.jhep.2016.04.005

• Garcia-Compean, D., Jaquez-Quintana, J. O., Gonzalez-Gonzalez, J. A., & Maldonado-Garza, H. (2009). Liver cirrhosis and diabetes: Risk factors, pathophysiology, clinical implications and management. World Journal of Gastroenterology, 15(3), 280. https://doi.org/10.3748/wjg.15.280

• Tilg, H., Moschen, A. R., & Roden, M. (2016). NAFLD and diabetes mellitus. Nature Reviews Gastroenterology & Hepatology, 14(1), 32–42. https://doi.org/10.1038/nrgastro.2016.147

• Lautamäki, R., Borra, R., Iozzo, P., Komu, M., Lehtimäki, T., Salmi, M., Jalkanen, S., Airaksinen, K. E., Knuuti, J., Parkkola, R., & Nuutila, P. (2006). Liver steatosis coexists with myocardial insulin resistance and coronary dysfunction in patients with type 2 diabetes. American Journal of Physiology-Endocrinology and Metabolism, 291(2), E282-E290. https://doi.org/10.1152/ajpendo.00604.2005

• Lomonaco, R., et al. (2012). Effect of ethnicity on body fat distribution and insulin sensitivity in obese Hispanic and African American youth. Diabetes Care, 35(6), 1337-1343.

• Dharmalingam, M., & Yamasandhi, P. G. (2018). Nonalcoholic fatty liver disease and type 2 diabetes mellitus. Indian journal of endocrinology and metabolism, 22(3), 421-428. https://journals.lww.com/indjem/fulltext/2018/22030/nonalcoholic_fatty_liver_disease_and_type_2.22.aspx

• Manciulli, G., et al. (2015). Albuminuria and NAFLD: Emerging evidence of a liver-kidney connection. Diabetes & Metabolism, 41(6), 405-412.

• Marchesini, G., et al. (2016). NAFLD and the metabolic syndrome: An updated perspective. Diabetes & Metabolism, 42(6), 389-397.

• De Marco, R., Locatelli, F., Zoppini, G., Verlato, G., Bonora, E., & Muggeo, M. (1999). Cause-specific mortality in type 2 diabetes. The Verona diabetes study. Diabetes Care, 22(5), 756-761. https://doi.org/10.2337/diacare.22.5.756

• Mathew, rev. Anthony Gervase, (14 March 1905–4 April 1976). (2007). Who Was Who. https://doi.org/10.1093/ww/9780199540884.013.u157268

• Musso, G., Gambino, R., Tabibian, J. H., Ekstedt, M., Kechagias, S., Hamaguchi, M., Hultcrantz, R., Hagström, H., Yoon, S. K., Charatcharoenwitthaya, P., George, J., Barrera, F., Hafliðadóttir, S., Björnsson, E. S., Armstrong, M. J., Hopkins, L. J., Gao, X., Francque, S., Verrijken, A., … Cassader, M. (2014). Association of non-alcoholic fatty liver disease with chronic kidney disease: A systematic review and meta-analysis. PLoS Medicine, 11(7), e1001680. https://doi.org/10.1371/journal.pmed.1001680

• Park, C. C., Nguyen, P., Hernandez, C., Bettencourt, R., Ramirez, K., Fortney, L., Hooker, J., Sy, E., Alquiraish, M., Valasek, M. A., Rizo, E., Richards, L. M., Brenner, D. A., Sirlin, C. B., & Loomba, R. (2017). Magnetic resonance Elastography vs transient Elastography in detection of fibrosis and Noninvasive measurement of steatosis in patients with biopsy-proven nonalcoholic fatty liver disease. Gastroenterology, 152(5), S70. https://doi.org/10.1016/s0016-5085(17)30587-5

• Polyzos, S. A., Toulis, K. A., Goulis, D. G., Zavos, C., & Kountouras, J. (2011). Serum total adiponectin in nonalcoholic fatty liver disease: a systematic review and meta-analysis. Metabolism, 60(3), 313-326. https://doi.org/10.1016/j.metabol.2010.09.003

• Prashanth, M., Ganesh, H. K., Vima, M. V., John, M., Bandgar, T., Joshi, S. R., ... & Shah, N. S. (2009). Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus. J Assoc Physicians India, 57(3), 205-210.

• Promrat, K., Kleiner, D. E., Niemeier, H. M., Jackvony, E., Kearns, M., Wands, J. R., Fava, J. L., & Wing, R. R. (2010). Randomized controlled trial testing the effects of weight loss on nonalcoholic Steatohepatitis. Hepatology, 51(1), 121-129. https://doi.org/10.1002/hep.23276

• Romeo, S., Kozlitina, J., Xing, C., Pertsemlidis, A., Cox, D., Pennacchio, L. A., Boerwinkle, E., Cohen, J. C., & Hobbs, H. H. (2008). Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nature Genetics, 40(12), 1461-1465. https://doi.org/10.1038/ng.257

• Targher, G., Bertolini, L., Padovani, R., Rodella, S., Tessari, R., Zenari, L., Day, C., & Arcaro, G. (2007). Prevalence of nonalcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients. Diabetes Care, 30(5), 1212-1218. https://doi.org/10.2337/dc06-2247

• Tilg, H., & Moschen, A. R. (2010). Evolution of inflammation in nonalcoholic fatty liver disease: The multiple parallel hits hypothesis. Hepatology, 52(5), 1836-1846. https://doi.org/10.1002/hep.24001

• Tomah, S., Alkhouri, N., & Hamdy, O. (2020). Nonalcoholic fatty liver disease and type 2 diabetes: Where do diabetologists stand? Clinical Diabetes and Endocrinology, 6(1). https://doi.org/10.1186/s40842-020-00097-1

• Vilar‐Gomez, E., Calzadilla‐Bertot, L., Friedman, S. L., Gra‐Oramas, B., Gonzalez‐Fabian, L., Villa‐Jimenez, O., Lazo‐del Vallin, S., Diago, M., Adams, L. A., Romero‐Gomez, M., & Chalasani, N. (2016). Improvement in liver histology due to lifestyle modification is independently associated with improved kidney function in patients with non‐alcoholic steatohepatitis. Alimentary Pharmacology & Therapeutics, 45(2), 332-344. https://doi.org/10.1111/apt.13860

• Wang, Y., Zhou, M., Lam, K. S., & Xu, A. (2009). Protective roles of adiponectin in obesity-related fatty liver diseases: Mechanisms and therapeutic implications. Arquivos Brasileiros de Endocrinologia & Metabologia, 53(2), 201-212. https://doi.org/10.1590/s0004-27302009000200012

• Wong, V. W., Wong, G. L., Yip, G. W., Lo, A. O., Limquiaco, J., Chu, W. C., Chim, A. M., Yu, C., Yu, J., Chan, F. K., Sung, J. J., & Chan, H. L. (2011). Coronary artery disease and cardiovascular outcomes in patients with non-alcoholic fatty liver disease. Gut, 60(12), 1721-1727. https://doi.org/10.1136/gut.2011.242016

• Yki-Järvinen, H. (2014). Non-alcoholic fatty liver disease as a cause and a consequence of metabolic syndrome. The Lancet Diabetes & Endocrinology, 2(11), 901-910. https://doi.org/10.1016/s2213-8587(14)70032-4

• Younossi, Z. M., Golabi, P., De Avila, L., Paik, J. M., Srishord, M., Fukui, N., Qiu, Y., Burns, L., Afendy, A., & Nader, F. (2019). The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis. Journal of Hepatology, 71(4), 793-801. https://doi.org/10.1016/j.jhep.2019.06.021

• Zhang, X., et al. (2020). Prevalence and risk factors for NAFLD in Asia. Liver International, 40(1), 29-38.

Downloads

Published

2025-04-16

Issue

Vol. 3 No. 4 (2025): Indus Journal of Bioscience Research

Section

Original Article

License

Copyright (c) 2025 Indus Journal of Bioscience Research

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

How to Cite

Frequency and Factors Associated with Non-Alcoholic Fatty Liver Disease in Patients with Diabetes Mellitus. (2025). Indus Journal of Bioscience Research, 3(4), 213-219. https://doi.org/10.70749/ijbr.v3i4.1039