Liver

7 - Development of Non-Alcoholic Fatty Liver Disease in type-2 Diabetics and Factors Associated With Its Development

Monday, October 8
9:42 AM - 9:54 AM
Location: Terrace Ballroom (level 400)

Category: Liver
Amandeep Singh, MD 1, Falgun Gosai, MD2, Rocio Lopez, MS3, Naim Alkhouri, MD4, Donald Kirby, MD5, Arthur McCullough, MD6
1Digestive Disease Institute/Cleveland Clinic, Cleveland, OH; 2Fairview Hospital, Cleveland Clinic, Cleveland, OH; 3Lerner Research Institute/Cleveland Clinic Foundation, Cleveland, OH; 4Texas Liver Institute, San Antonio, TX; 5Cleveland Clinic, Cleveland, OH; 6Cleveland Clinic Foundation, Cleveland, OH

Award: Fellows-in-Training Award (Liver Category)

Introduction: Nonalcoholic fatty liver disease (NAFLD) could have a bidirectional nature in type-2 diabetics (T2D), but there is paucity of data on this issue. The aim of this study was to assess the development and regression of NAFLD in a large cohort of diabetics and define factors associated with worsening or improvement in NAFLD.

Methods: Using ICD-9 codes, all T2D between 2000-2015 were identified. Baseline demographics, clinical and laboratory data were collected. Hepatic steatosis index (HSI>36) was calculated to assess NAFLD at baseline (BL) and then recalculated using last follow up (LF) lab values to assess the presence or absence of NAFLD. Patients were divided into 4 groups as follows:  No NAFLD at either time (BL and LF), NAFLD both times, development of NAFLD at LF from no NAFLD at BL regression of NAFLD from BL to no NAFLD at LF.  A univariable and a multivariable logistic regression analysis were done to further assess which clinical factors are associated with transition in NAFLD status

Results: A total of 50,695 subjects are included in the analysis with a mean age of 51.2±11.6 at BL and 59.6±11.6 years at LF. Median time between 1st and last available labs was 84.4 (24 -199) months. The cohort was comprised of 55.3% females and 71% Caucasians. The mean platelet count and HbA1c at baseline was 251 [208, 299] and 6.6 [6.0, 7.9], respectively. Interestingly, the prevalence of obesity, HTN, CKD, hyperlipidemia and CAD increased during this period (p<0.001 for all). During this period, 8.9% of subjects transitioned from no evidence of NAFLD to NAFLD (progression), 2.2% transition from NAFLD to NAFLD (regression) and, the rest stayed stable (Figure 1). Clinical factors associated with progression included: female gender, African-American race, and the presence of baseline obesity, HTN or high ALT levels. Use of oral hypoglycemics and diuretics was also associated with progression to NAFLD (p<0.05 for all) (Table 1). Being male, non-Caucasians, high baseline AST and albumin, and pentoxifylline use were associated with the regression of NAFLD (p<0.05) (Table 2).

Discussion: We provide data on the natural history of the directionality of NAFLD in a large cohort of T2D patients based on noninvasive fatty liver score. NAFLDregressed in 2.2% of the patients without any NAFLD-specific interventions despite increase in the prevalence of risk factors. The effects of commonly used diabetic medications and pentoxifylline on NAFLD progression should be further analyzed.


Disclosures:
Amandeep Singh indicated no relevant financial relationships.
Falgun Gosai indicated no relevant financial relationships.
Rocio Lopez indicated no relevant financial relationships.
Naim Alkhouri indicated no relevant financial relationships.
Donald Kirby indicated no relevant financial relationships.
Arthur McCullough indicated no relevant financial relationships.

Amandeep Singh

Cleveland Clinic Foundation
Cleveland, Ohio

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