Non alcoholic fatty liver disease and its relationship with hsCRP in type 2 diabetes mellitus

Authors

  • Naina Bhuyan Department of Medicine, Assam Medical College, Dibrugarh-786002, Assam
  • Mridupawan Gogoi Department of Medicine, Assam Medical College, Dibrugarh-786002, Assam
  • Vineet Todi Department of Medicine, Assam Medical College, Dibrugarh-786002, Assam
  • Ajit Pegu Department of Medicine, Assam Medical College, Dibrugarh-786002, Assam
  • Anup K. Das Department of Medicine, Assam Medical College, Dibrugarh-786002, Assam

Keywords:

NAFLD, Fatty liver, Diabetes mellitus, NASH, hsCRP, NAFLD markers, Type 2 diabetes

Abstract

Background: Diabetes mellitus is assuming an epidemic form in India. Non-alcoholic fatty liver disease worldwide is increasing too and is a major cause of liver transplant in the west. Diabetes is a strong risk factor for non-alcoholic fatty liver disease, and some of them go on to develop steatohepatitis which is associated with a more rapid disease progression leading to chronic liver disease including hepatocellular carcinoma. This association of diabetes with fatty liver disease is least investigated. Liver biopsy is not routinely done in clinical practice and various non-invasive markers for fatty liver or steatohepatitis are used frequently to identify patients at risk of fatty liver disease.

Methods: 116 Type 2 Diabetics Mellitus on therapy with oral anti-diabetic drugs and atorvastatin for at least 3 months’ duration were included and sonologically evaluated for fatty liver after proper exclusion of other causes of fatty liver. Serum hsCRP, an acute phase reactant, was measured in them. Liver function tests, BMI and other necessary investigations were done. 144 healthy controls were also taken.

Results: The absolute risk of developing fatty liver was significantly high in T2 diabetics compared to controls. hsCRP was significantly associated with fatty liver and uncontrolled glycemic status. In addition AST/ALT > 1 also showed significant differences amongst the same groups.

Conclusions: High hsCRP is a cheap, easily available laboratory marker to suspect fatty liver and possibly steatohepatitis in T2 Diabetics in our region. It can identify a subgroup of diabetic patients in whom liver biopsy may be advisable to confirm steatohepatitis which is important for prognosis and therefore need aggressive intervention.

 

References

Chitturi S, Abeygunasakera S, Farrell GC, Holmes-Walker J, Hui JM, Fung C et al. NASH and insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology. 2002;35: 373–379.

Younossi ZM. Review article: current management of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Aliment Pharmacol Ther. 2008;28(1):2-12.

Byrne CD, Olufadi R, Bruce KD, Cagampang FR, Ahmed MH. Metabolic disturbances in non-alcoholic fatty liver disease. Clin Sci (Lond). 2009; 116(7):539-564.

Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002;346: 1221–1231.

Clark J and Diehl A. Hepatic steatosis and type 2 diabetes mellitus. Curr Diab Rep 2002:2: 210–215.

Kumar KS and Malet PF. Nonalcoholic steatohepatitis. Mayo Clin Proc 2000;75: 733–739.

Day C and Saksena S. Nonalcoholic steatohepatitis: definitions and pathogensis. J Gastroenterol Hepatol 2002:17: S377–S384.

Knobler H, Schattner A, Zhornicki T, Malnick SDH, Keter D, Sokolovskaya N et al. Fatty liver—an additional and treatable feature of the insulin resistance syndrome. Q J Med 1999;92: 73–79.

Adams LA, Lymp J, St Sauver J. The natural history of nonalcoholic fatty liver disease: a population based cohort study. Gastroenterology 2005;129: 113–21.

Fassio E, Alvarez E, Dominguez N. Natural history of nonalcoholic steatohepatitis: a longitudinal study of repeat liver biopsies. Hepatology 2004;40:820–826.

Barzilay JI, Abraham L, Heckbert SR, Cushman M, Kuller LH. The relation of markers of inflammation to the development of glucose disorders in the elderly: the Cardiovascular Health Study. Diabetes 2001; 50: 2384–2389.

Fierbinteanu-Braticevici C, Baicus C, Tribus L, Papacocea R. Predictive factors for nonalcoholic steatohepatitis (NASH) in patients with nonalcoholic fatty liver disease (NAFLD). J Gastrointestin Liver Dis. 2011 Jun;20(2):153-159.

Haukeland JW, Damås JK, Konopski Z, Løberg EM, Haaland T, Goverud I et al. Systemic inflammation in nonalcoholic fatty liver disease is characterized by elevated levels of CCL2. J Hepatol. 2006; 44:1167–1174.

Yoneda M, Mawatari H, Fujita K, Iida H, Yonemitsu K, Kato S et al. High-sensitivity C-reactive protein is an independent clinical feature of nonalcoholic steatohepatitis (NASH) and also of the severity of fibrosis in NASH. J Gastroenterol. 2007;42:573–582.

Riquelme A, Arrese M, Soza A, Morales A, Baudrand R, Pérez-Ayuso RM et al. Non-alcoholic fatty liver disease and its association with obesity, insulin resistance and increased serum levels of C-reactive protein in Hispanics. Liver Int. 2009; 29: 82–88.

Jimba S, Nakagami T, Taikahashi M. Prevalence of non-alcoholic fatty liver disease and its association with impaired glucose metabolism in Japanese adults. Diabet Med. 2005;22(9):1141-1145.

Marchesini G, Bugianesi E, Forlani G. Nonalcoholic fatty liver, steatohepatitis and the metabolic syndrome. Hepatology. 2003;37:917-923.

Neuschwander-Tetri BA, Clark JM, Bass NM. Clinical, laboratory and histological associations in adults with non-alcoholic fatty liver disease. Hepatology. 2010;52:913-924.

Day CP. Pathogenesis of steatohepatitis, Best Pract Res Clin Gastroenterol 2002; 16:663-678.

Adams LA, Angulo P. Role of liver biopsy and serum markers of liver fibrosis in non-alcoholic fatty liver disease. Clin Liver Dis. 2007; 11:25-35.

Ratziu V, Charlotte F, Heurtier A, Gombert S, Giral P, Bruckert E et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology.2005;128:1898–1906.

Merriman RB, Ferrell LD, Patti MG, Weston SR, Pabst MS, Aouizerat BE et al. Correlation of paired liver biopsies in morbidly obese patients with suspected nonalcoholic fatty liver disease. Hepatology. 2006;44:874–80.

Vuppalanchi R, Unalp A, Natta MV, Cummings O, Wass J, Tonascia J et al. Increased diagnostic yield from liver biopsy in suspected NAFLD using multiple cores and mutiple readings. Gastroenterology. 2007;132:A809.

Duvnjak M, Lerotić I, Barsić N, Tomasić V, Virović Jukić L, Velagić V. Pathogenesis and management issues for non-alcoholic fatty liver disease. World J Gastroenterol. 2007; 14;13(34):4539-4550.

Browning JD. New imaging techniques for non-alcoholic steatohepatitis. Clin Liver Dis. 2009;13:607-619.

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Published

2017-01-26

How to Cite

Bhuyan, N., Gogoi, M., Todi, V., Pegu, A., & Das, A. K. (2017). Non alcoholic fatty liver disease and its relationship with hsCRP in type 2 diabetes mellitus. International Journal of Research in Medical Sciences, 2(4), 1586–1590. Retrieved from https://www.msjonline.org/index.php/ijrms/article/view/2466

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Original Research Articles