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Preperitoneal, visceral fat predict steatosis, fibrosis in type 2 diabetes

Measurement of preperitoneal and visceral fat areas with magnetic resonance imaging provided a noninvasive marker to predict liver steatosis and fibrosis in patients with type 2 diabetes at risk for severe nonalcoholic fatty liver disease, according to recently published data.

“Patients with diabetes are at an increased risk of NAFLD and are prone to the development of steatohepatitis and fibrosis, the more aggressive forms of the disease,” Daniella Braz Parente, MD, PhD, from the Federal University of Rio de Janeiro, Brazil, and colleagues wrote. “Screening of the entire diabetic population with liver biopsy, an invasive procedure associated with complication risks, is not feasible. However, the identification of steatohepatitis and fibrosis is important because these conditions are dynamic and may improve with treatment. Therefore, the development of non-invasive markers of increased risks of [nonalcoholic steatohepatitis (NASH)] and fibrosis is needed.”

Between June 2010 and Feb. 2012, Parente and colleagues enrolled 66 patients in their study. Mean patient age was 53.9 years (range, 26-68), mean time from diabetes diagnosis was 11 years, most were women (82%), 34% were overweight, 63% were obese, and all underwent liver biopsy.

Histological results showed that 9% of patients had normal livers, 45% had mild steatosis, 29% had severe steatosis, 35% had steatohepatitis and 33% had fibrosis.

Visceral adipose tissue (P = .008) and preperitoneal fat (P = .037) correlated with the presence of liver fibrosis, both correlated with histopathological liver steatosis grade (P = .004), and both along with subcutaneous adipose tissue correlated with the presence of steatohepatitis (P .002).

As noninvasive markers, visceral adipose tissue was the best predictor of steatosis (R² = 0.233) and fibrosis (R² = 0.181). While all abdominal fat areas showed good predictive measure of steatohepatitis, preperitoneal fat areas best explained model variability (R² = 0.379).

The preperitoneal fat area threshold of 5 cm² (range, 4.8-5 cm²) had a 93% sensitivity and 55% specificity for predicting steatohepatitis. The visceral adipose tissue threshold of 109 cm² (range, 59-140 cm²) had a 77% sensitivity and 79% specificity for predicting fibrosis.

“Abdominal fat areas, especially the preperitoneal fat area, may become potential noninvasive markers of more aggressive forms of liver disease that may be used in the screening of patients with type 2 diabetes,” the researchers wrote. “The role of preperitoneal fat and visceral fat areas to predict the severity of NAFLD in type 2 diabetes has to be carefully validated in studies with larger samples.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.