Endocrine Abstracts

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is the presence of hepatic steatosis in the absence of other causes for secondary hepatic fat accumulation. The incidence and the prevalence of the NAFLD has risen exponentially in the recent past especially in the patients with diabetes. We have studied the prevalence of NAFLD in patients with diabetes attending the diabetes clinic based on the biochemical and ultrasonic criteria, the risk factors for disease development and associated comorbidities.

Methods: A descriptive cross sectional study was conducted from August 2020 to March 2021 at the Diabetes Unit of the National Hospital of Sri Lanka. Systematic sampling was done recruiting participants who are attending the diabetic clinic for annual end organ screening. After obtaining informed written consent, the data was collected using an interviewer administered questionnaire. The diagnosis of NAFLD is made according to the NHANES III criteria and the USS criteria. Categorical and numerical variables were analyzed using Chi-square and independent sample t-tests respectively. Multiple linear regression was used to determine the predictors of NAFLD diagnosis.

Results: The study enrolled hundred and one patients. The mean age was 58.3 years (range 23-80) and 69.3% were females. The mean weight was 65.7 (SD=12.5) kg and BMI was 26.8 (SD=4.7) kg/m^-2. The prevalence of NAFLD according to the biochemical and/or USS criteria was 72.3% (n=73). Out of that 34.7% met both biochemical and USS criteria. Furthermore, 7.9% (n=8) met only the biochemical criteria while 29.7% (n=30) met only the USS criteria. More females were diagnosed with NAFLD compared to males (P=0.009). Pioglitazone use was protective against the development of NAFLD (P=0.000). The younger age (P= 0.021), higher HbA1c (P=0.033), higher Body mass index (BMI) (P=0.014) are other statistically significant factors contributing to the development of NAFLD. Multiple linear regression model identified BMI (P=0.002), pioglitazone use (P=0.002), gender (P=0.000) as predictors of diagnosis of NAFLD.

Conclsions: The prevalence of NAFLD is higher in the diabetes patients when compared to the general population. The use of biochemical criteria only identifies a proportion of patients with NAFLD. Early diagnosis with suitable tests will allow early intervention and prevention of long term deleterious complications. Optimization of modifiable factors such as high HbA1c, BMI is paramount in the prevention of the disease development. Further large scale studies including community studies are needed to recognize the current prevalence of NAFLD in the general as well as diabetic populations.