SFEBES2023 Poster Presentations Metabolism, Obesity and Diabetes (70 abstracts)
The role of glycated haemoglobin in predicting disease severity in non-alcoholic fatty liver disease
Santo Colosimo 1,2 , Hamish Miller 1 , Dimitrios Koutoukidis 1 , Thomas Marjot 1 , Garry Tan 3 , David Harman 4 , Guruprasad Aithal 5 , Pinelopi Manousou 6 , Roberta Forlano 6 , Richard Parker 7 , David Sheridan 8 , Philip Newsome 9 , William Alazawi 10 , Jeremy Cobbold 3 & Jeremy Tomlinson 1
1University of Oxford, Oxford, United Kingdom. 2University of Milan, Milan, Italy. 3Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom. 4Royal Berkshire Hospitals NHS Foundation Trust, Reading, United Kingdom. 5University of Nottingham, Nottingham, United Kingdom. 6Imperial College London, London, United Kingdom. 7Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom. 8University of Plymouth, Plymouth, United Kingdom. 9University of Birmingham, Birmingham, United Kingdom. 10Queen Mary University of London, London, United Kingdom
Introduction: The relationship between non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes is well-established. However, the precise impact of glucose control on the severity and progression of NAFLD remains largely unexplored. Currently, none of the non-invasive scoring systems used to assess NAFLD severity incorporate glucose control markers, such as glycated hemoglobin (HbA1c).
Methods: Data were collected from a cohort of 857 patients with NAFLD, including liver histological staging, HbA1c levels, and body mass index (BMI). Generalized linear regression models and binomial regression analysis were employed to assess the relationships between histological NAFLD severity, age, HbA1c, and BMI. Furthermore, paired biopsies from interventional studies involving 421 patients were utilized to evaluate the impact of weight changes, HbA1c levels, and active vs placebo treatment on improvements in steatosis, non-alcoholic steatohepatitis (NASH), and fibrosis.
Results: In our discovery cohort (n=687), we found a positive correlation between HbA1c levels and the risk of severe steatosis, NASH, and advanced fibrosis, even after adjusting for obesity and age. These findings were confirmed through analysis of a separate validation cohort (n=170). Predictive modeling incorporating HbA1c and age was found to be non-inferior to the established non-invasive biomarker, Fib-4. Furthermore, we developed risk charts adjusted for HbA1c, age, and BMI to predict NAFLD severity. Within the interventional cohort, reductions in HbA1c were associated with improvements in both steatosis and NASH, independent of weight changes and treatment. However, changes in fibrosis were only associated with weight changes and treatment, not HbA1c levels.
Conclusion: Our study highlights the high informativeness of HbA1c in predicting NAFLD severity, surpassing the significance of BMI alone. We propose that HbA1c assessments should be an integral part of the holistic evaluation of NAFLD patients. Combined with age, HbA1c can effectively identify patients at the highest risk of advanced disease.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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