Diabetes Mellitus Predicts Occurrence of Cirrhosis and Hepatocellular Cancer in Alcoholic Liver and Non-alcoholic Fatty Liver Diseases

摘要

Background and Aims:Alcohol abuse and nonalcoholic fatty liver disease (NAFLD) are common causes of liver disease.Diabetes mellitus (DM) is a common comorbidity among NAFLD patients.We performed this study with the specific aim to examine the impact of DM on progression of alcoholic liver disease (ALD) liver and NAFLD.Methods:Medical charts of 480 patients with ALD or NAFLD (2004-2011) managed at a tertiary center were retrospectively reviewed.NAFLD was diagnosed based on exclusion of other causes of liver disease and alcohol use of ＜10 g/d.ALD was diagnosed based on alcohol use of ＞40 g/d in women or ＞60 g/d in men for ＞5years.Results:Of 480 patients (307 NAFLD),200 diabetics differed from nondiabetics for:age (52±11 vs.49±11 years;p=0.004);male gender (48％ vs.57％;p=0.03);metabolic syndrome (49％ vs.30％;p=0.0002);NAFLD (80％ vs.56％;p＜0.0001);cirrhosis (70％ vs.59％;p=0.005);and hepatocellular carcinoma (HCC;8％ vs.3％;p=0.009).Over a 3 year median follow-up period,diabetics relative to nondiabetics had a higher probability to develop cirrhosis (60％ vs.41％;p=0.022) and HCC (27％ vs.10％;p=0.045).There was a trend for increased development of hepatic encephalopathy in diabetics compared to nondiabetics (55％ vs.39％;p=0.053),and there was no difference between the two groups in survival or other liver disease complications.Conclusions:DM increased risk for cirrhosis and HCC among patients with ALD and NAFLD.Prospective studies with longer follow-up periods are needed to examine the impact of DM on survival and the role of aggressive HCC screening in diabetic cirrhotics.