Yonsei Med J.  2016 Jul;57(4):885-892. 10.3349/ymj.2016.57.4.885.

The Relationship between Type 2 Diabetes Mellitus and Non-Alcoholic Fatty Liver Disease Measured by Controlled Attenuation Parameter

• Chon YE
• Kim KJ
• Jung KS
• Kim SU
• Park JY
• Kim DY
• Ahn SH
• Chon CY
• Chung JB
• Park KH
• Bae JC
• Han KH

• KMID: 2374119
• DOI: http://doi.org/10.3349/ymj.2016.57.4.885

Abstract

PURPOSE
The severity of non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes mellitus (T2DM) population compared with that in normal glucose tolerance (NGT) individuals has not yet been quantitatively assessed. We investigated the prevalence and the severity of NAFLD in a T2DM population using controlled attenuation parameter (CAP).
MATERIALS AND METHODS
Subjects who underwent testing for biomarkers related to T2DM and CAP using Fibroscan® during a regular health check-up were enrolled. CAP values of 250 dB/m and 300 dB/m were selected as the cutoffs for the presence of NAFLD and for moderate to severe NAFLD, respectively. Biomarkers related to T2DM included fasting glucose/insulin, fasting C-peptide, hemoglobin A1c (HbA1c), glycoalbumin, and homeostasis model assessment of insulin resistance of insulin resistance (HOMA-IR).
RESULTS
Among 340 study participants (T2DM, n=66; pre-diabetes, n=202; NGT, n=72), the proportion of subjects with NAFLD increased according to the glucose tolerance status (31.9% in NGT; 47.0% in pre-diabetes; 57.6% in T2DM). The median CAP value was significantly higher in subjects with T2DM (265 dB/m) than in those with pre-diabetes (245 dB/m) or NGT (231 dB/m) (all p<0.05). Logistic regression analysis showed that subjects with moderate to severe NAFLD had a 2.8-fold (odds ratio) higher risk of having T2DM than those without NAFLD (p=0.02; 95% confidence interval, 1.21-6.64), and positive correlations between the CAP value and HOMA-IR (ρ=0.407) or fasting C-peptide (ρ=0.402) were demonstrated.
CONCLUSION
Subjects with T2DM had a higher prevalence of severe NAFLD than those with NGT. Increased hepatic steatosis was significantly associated with the presence of T2DM, and insulin resistance induced by hepatic fat may be an important mechanistic connection.

Keyword

Controlled attenuation parameter; fatty liver; non-alcoholic fatty liver disease; type 2 diabetes mellitus; pre-diabetes; insulin resistance

MeSH Terms

Adult
Aged
Biomarkers/metabolism
C-Peptide/metabolism
Case-Control Studies
Diabetes Mellitus, Type 2/*complications/metabolism
Female
Hemoglobin A, Glycosylated/metabolism
Humans
Insulin Resistance
Male
Middle Aged
Non-alcoholic Fatty Liver Disease/*epidemiology/metabolism/pathology
Odds Ratio
Prevalence
Biomarkers
C-Peptide
Hemoglobin A, Glycosylated

Figure

• 

  Fig. 1 Prevalence of NAFLD according to the glucose tolerance status. (A) Subjects with NAFLD (CAP value ≥250 dB/m) increased according to the glucose tolerance status (31.9% in NGT; 47.0% in pre-diabetes; 57.6% in T2DM) (black bar). Subjects with moderate to severe NAFLD (CAP value ≥300 dB/m) increased according to the glucose tolerance status (9.7% in NGT; 15.3% in pre-diabetes; 33.3% in T2DM) (white bar). (B) Subjects with presence of NAFLD (diagnosed by ultrasonography) increased according to the glucose tolerance status (27.8% in NGT; 35.6% in pre-diabetes; 54.5% in T2DM) (black bar). Subjects with moderate to severe NAFLD (diagnosed by ultrasonography) increased according to the glucose tolerance status (6.9% in NGT; 8.4% in pre-diabetes; 22.7% in T2DM) (white bar). NAFLD, non-alcoholic fatty liver disease; CAP, controlled attenuation parameter; NGT, normal glucose tolerance; T2DM, type 2 diabetes mellitus.

• 

  Fig. 2 Severity of NAFLD according to the glucose tolerance status. (A) Subjects with T2DM had significantly higher median CAP values than those with NGT (265 dB/m vs. 231 dB/m, p<0.001) or pre-diabetes (265 dB/m vs. 245 dB/m, p=0.003). (B) In subjects with NAFLD (CAP value ≥250 dB/m), the median CAP value increased according to the glucose tolerance status: 259 dB/m, 278 dB/m, and 304 dB/m in NGT, pre-diabetes, and T2DM groups, respectively (comparison between groups: T2DM vs. NGT, p=0.006; T2DM vs. pre-diabetes, p=0.026; pre-diabetes vs. NGT, p=0.077). (C) In subjects with NAFLD (diagnosed by ultrasonography), the median CAP values increased according to the glucose tolerance status: 265 dB/m in NGT, 278 dB/m in pre-diabetes, and 302 dB/m in T2DM group (comparison between groups; T2DM vs. NGT, p=0.042; T2DM vs. pre-diabetes, p=0.047; pre-diabetes vs. NGT, p=0.484). NAFLD, non-alcoholic fatty liver disease; CAP, controlled attenuation parameter; T2DM, type 2 diabetes mellitus; NGT, normal glucose tolerance.

• 

  Fig. 3 HOMA-IR and fasting C-peptide level according to CAP values. (A) HOMA-IR was significantly higher in the group with CAP value ≥300 dB/m compared with the groups with CAP value of 250–300 or <250 dB/m (HOMA-IR, 3.00±1.99 vs. 1.64±1.04 vs. 1.63±2.59, respectively; p<0.001). (B) Subjects with CAP value >300 dB/m showed significantly higher fasting C-peptide than those with CAP value of 250–300 dB/m or <250 dB/m (fasting C-peptide, 2.71±0.95 ng/mL vs. 2.29±1.62 ng/mL vs. 1.97±0.88 ng/mL, respectively; p<0.001). HOMA-IR, homeostasis model assessment of insulin resistance; CAP, controlled attenuation parameter.

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