This article is more than 5 years old. Information may no longer be current.

Diabetes may be associated with liver fibrosis in patients with hemochromatosis

An association may exist between the presence of diabetes and severe liver fibrosis in patients with hereditary hemochromatosis, according to recent study results.

In a retrospective chart review, researchers evaluated data from 291 patients (mean age, 42.5 years; 67.4% male) with hereditary hemochromatosis who underwent liver biopsy between 1964 and 2007 at a single medical facility. Incorporated data included age, gender, medical history, tobacco and alcohol consumption, metabolic risk factors and laboratory results.

Across the cohort, 56% had stage F0, 13.8% F1, 11.0% F2, 5.8% F3 and 13.4% F4 fibrosis. Multivariate analysis of a subgroup of 119 patients with increased fibrosis indicated a strong association between fibrosis and diabetes (OR=7.32; 95% CI, 1.21-44.37), with other associated factors including male gender (OR=3.52; 95% CI, 1.29-9.56), excessive drinking (a mean of more than 60 g/day for males; 40 g/day for females) (OR=4.25; 95% CI, 1.49-12.20) and hepatic iron concentration (OR=1.3; 95% CI, 1.10-1.54). Although patients with diabetes were a minority among those with severe fibrosis, diabetes was more common among patients with stage 3 or 4 fibrosis than among those with lower stages (nine patients vs. four).

Investigators also established a borderline association between higher fibrosis and steatosis (OR=2.48; 95% CI, 1.00-6.15), which was present in 106 participants. Male gender, impaired glucose tolerance and increased BMI were associated with an increased risk for hepatic steatosis. Patients with diabetes at biopsy were not at increased risk (OR=1.28, P=.669), but patients who developed impaired glucose tolerance during follow-up were (OR=4.12, P=.004).

“These findings further clarify factors modifying the progression of hepatic fibrosis and cirrhosis in C282Y hemochromatosis,” the researchers wrote. “In particular, this study has demonstrated an association between the presence of diabetes and higher fibrosis stage. The mechanism for this association is unknown and deserves further evaluation; however, it is possible that diabetes produces an additional hepatic oxidative injury from hyperglycemia. Thus, management of such cofactors in patients with hemochromatosis is important to reduce the risk of liver injury and fibrosis.”