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Researchers find liver fibrosis associated with diabetes, steatosis
In The Rotterdam Study, researchers found that liver stiffness is strongly associated with steatosis and diabetes, indicating that as the prevalence of steatosis and diabetes increases, liver fibrosis could become a major public health problem, according to published findings.
“To date, limited studies have been performed focusing on the prevalence of, and risk factors for liver fibrosis in the general population, as data are mainly derived from autopsy studies or biopsy studies in selected populations,” the researchers wrote. “The aim of our study was to investigate the distribution of and factors associated with clinically relevant liver fibrosis, as measured by [transient elastography], in a large population-based cohort of Caucasians.”
Sarwa Darwish Murad, MD, PhD, department of gastroenterology and hepatology, Erasmus MC University Hospital, The Netherlands, and colleagues analyzed data of 3,041 people involved in the Rotterdam study, a population-based study among people at least 45 years of age, living in Rotterdam. All of the participants underwent abdominal ultrasound via Hitachi HI VISION 900 and transient elastography via the Fibroscan (EchoSens) to measure liver stiffness. A cut-off measurement of 8 kPa or greater for liver stiffness measurement (LSM) was used, as it suggests evidence of fibrosis, according to the research.
Of the patients, 55% were women, the mean age was 66 ± 7.6 years and the mean BMI was 27.3 ± 4 kg/m2.
Overall, 5.6% of people had LSM of 8 kPa or greater (n = 169) and 0.6% had LSM greater than 13 kPa (n = 19), suggesting evidence of advanced fibrosis or cirrhosis. The median LSM was 4.7 kPa and 35.5% of participants showed evidence of steatosis on abdominal ultrasound (n = 1,080).
Multivariate analyses showed combined presence of diabetes mellitus and steatosis (OR = 5.2; 95% CI, 3.01-8.98; P < .001), age (OR = 2.4; 95% CI, 1.72-3.36, P < .001), spleen size (OR = 1.23; 95% CI, 1.09-1.4, P = .001), alanine aminotransferase serum (OR = 1.24; 95% CI, 1.12-1.38; P < .001), smoking (OR = 1.77; 95% CI, 1.16-2.7, P = .008) and hepatitis B surface antigen or anti-HCV positivity (OR = 5.38; 95% CI, 1.6-18; P = .006) to be associated with LSM of 8 kPa or greater.
The adjusted predicted probability of LSM of 8 kPa or greater increased per age-decade, with a probability of 1.4% in people aged between 50 and 60 years and a probability of 9.9% in participants aged greater than 80 years. People with both diabetes mellitus and steatosis had the highest probabilities of LSM of 8 kPa or greater, with an overall probability of 17.2%. However, this probability did not increase with age (P = .8).
“In the context of an aging population and an increasing prevalence of diabetes and obesity, the findings illustrate that liver fibrosis may soon become a more prominent public health issue,” Murad said in a press release.
Disclosures: Healio.com/Hepatology was unable to confirm relevant financial disclosures at the time of publication.
Perspective
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We have an aging population in Western countries and obesity is at epidemic levels, leading to more people developing type 2 diabetes and fatty liver. This study suggests that the number of people with significant fibrosis is likely to increase over the next few years leading to more patients developing liver cirrhosis and its complication and needing a liver transplantation.
This study provides further support on the need to screen high risk patients such as older subjects with type 2 diabetes for the presence of fatty liver disease and liver fibrosis. Two-thirds of patients with type 2 diabetes have fatty liver and approximately 10% have advanced fibrosis, yet current practice guidelines do not recommend routine screening due to uncertainties about diagnostic tests and treatment. However, with new developments in noninvasive testing for liver fibrosis and promising results of recent clinical trials for fatty liver, it might be time to change the recommendations and start screening.
Similar studies are needed in the U.S. that include other ethnic groups such as African Americans and Hispanics to determine the prevalence of significant fibrosis.