NAFLD has ‘bidirectional’ course in patients with type 2 diabetes

PHILADELPHIA – Nonalcoholic fatty liver disease may have a “bidirectional” nature in patients with type 2 diabetes as NAFLD regressed in 2.2% of patients without any NAFLD-specific interventions despite increase in the prevalence of risk factors, according to a presentation at the American College of Gastroenterology Annual Meeting.

“With increasing prevalence of metabolic syndrome, prevalence of NAFLD has increased,” Amandeep Singh, MD, from Stanford University in California, said during his presentation. “NAFLD is projected to be the most common indication for liver transplantation in coming years and diabetes is a major risk factor for progressive disease in NAFLD patients.”

To assess the development and regression of NAFLD in patients with type 2 diabetes, Singh and colleagues analyzed the data of 50,695 patients over a median follow-up of 84.4 months (range, 24-199 months).

During follow-up, 80.5% of patients had NAFLD and their status did not change, 8.9% of patients developed NAFLD, 8.4% did not have NAFLD at any point, and 2.2% of patients with NAFLD regressed to a “no NAFLD” status.

The prevalence of obesity, hypertension, chronic kidney disease, hyperlipidemia and coronary artery disease increased among all patients during the study period (P < .001).

Clinical factors associated with NAFLD progression included female sex (OR = 1.71; 95% CI, 1.56-1.87), African-American ethnicity (OR = 1.27; 95% CI, 1.13-1.42), higher baseline alanine aminotransferase (OR = 1.68; 95% CI, 1.56-1.81), and presence of hypertension (OR = 1.14; 95% CI, 1.03-1.26) and obesity (OR = 1.61; 95% CI, 1.4-1.85).

According to Singh, women had a 71% higher rate of NAFLD progression compared with men and patients with obesity had nearly 60% higher odds of developing NAFLD.

In contrast, the factors associated with NAFLD regression included male sex (OR = 2.4; 95% CI, 2.11-2.73), ethnicity other than Caucasian (OR = 1.65; 95% CI, 1.31-2.08), higher baseline aspartate aminotransferase (OR = 1.72; 95% CI, 1.61-1.83) and albumin (OR = 1.22; 95% CI, 1.13-1.32), and use of pentoxifylline (OR = 2.66; 95% CI, 1.44-4.9).

“The effects of commonly used diabetic medications and pentoxifylline on the clinical course of NAFLD should be further analyzed,” Singh concluded. – by Talitha Bennett

Reference : Singh A, et al. Abstract 7. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.

Disclosure: Singh reports no relevant financial disclosures.