Clinical spectrum of non-alcoholic fatty liver disease in diabetic and non-diabetic patients

摘要

Background While non-alcoholic fatty liver disease (NAFLD) has been well characterised in patients with diabetes mellitus (DM), less is known about {NAFLD} in non-DM patients. We investigated the clinical characteristics of {NAFLD} patients with and without {DM} and accuracy of the {NAFLD} fibrosis score (NFS) in these two {NAFLD} groups. Methods Clinical, biochemical and histological variables were evaluated in this prospective cross-sectional study of 503 patients with biopsy proven NAFLD. Comparisons between patients with and without {DM} were analysed. {NFS} was correlated with liver histology to assess its robustness in patients with and without DM. Results There were 503 biopsy proven {NAFLD} patients with 48% of the cohort being diabetic. Relative to patients without DM, patients with {DM} were older (52 vs. 46 years, p < 0.001), with higher proportion of females (70% vs. 54%, p < 0.001), higher {BMI} (37 vs. 35, p = 0.009), higher prevalence of hypertension (73% vs. 44%, p < 0.001), higher prevalence of {NASH} (80.2% vs. 64.4%; p < 0.001) and advanced fibrosis (40.3% vs. 17.0%; p < 0.001). A considerable amount of patients without {DM} still had {NASH} (64%) and advanced fibrosis (17%). The clinical utility of the {NFS} differed between {NAFLD} patients with and without DM, with sensitivity to exclude advanced fibrosis being 90% of {NAFLD} patients with {DM} but only 58% of patients without DM. Conclusion Patients with {DM} have more severe {NAFLD} based on histology. However, {NASH} and advanced fibrosis also occur in a considerable proportion of {NAFLD} patients without DM. The lower utility of the {NFS} in {NAFLD} patients without {DM} emphasises the heterogeneous nature of the {NAFLD} phenotype.