NAFLD/NASH: T2DM predicts progression to cirrhosis, liver cancer

  • Alexander M & al.
  • BMC Med
  • 20 May 2019

  • International Clinical Digest
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Takeaway

  • Type 2 diabetes mellitus (T2DM) is a strong predictor of liver disease progression in patients with nonalcoholic fatty liver disease (NAFLD) and the more advanced nonalcoholic steatohepatitis (NASH).

Why this matters

  • NAFLD remains underdiagnosed, and findings warrant close monitoring of liver function in patients with T2DM.

Study design

  • 18,782,281 adults in 4 primary care databases in the UK, Netherlands, Italy, and Spain.
  • 136,703 patients with NAFLD/NASH were matched with up to 100 non-NAFLD control patients by age, sex, practice site, and time of most recent visit.
  • Median follow-up, 3.3 years.
  • Funding: European Research Council, National Institute for Health Research.

Key results

  • Patients with NAFLD/NASH were more likely to have diabetes (19.8% vs 9.6%), hypertension (42.2% vs 29.6%), and obesity (36.0% vs 15.4%) than matched controls.
  • For patients with NAFLD/NASH, incidence (per 1000 person-years) was 0.76 (95% CI, 0.46-2.32) for cirrhosis and 0.3 (95% CI, 0.26-0.60) for hepatocellular carcinoma (HCC).
  • Compared with controls, patients with NAFLD/NASH had more than:
    • Quadrupled risk for cirrhosis (pooled HR=4.73; 95% CI, 2.43-9.19).
    • Tripled risk for HCC (pooled HR=3.51; 95% CI, 1.72-7.16).
  • Risks were significantly higher with high vs indeterminate/low fibrosis scores.
  • In patients with NAFLD/NASH, baseline T2DM was the strongest predictor of cirrhosis/HCC (HR=2.3; 95% CI, 1.9-2.78).

Limitations

  • Reliance on diagnostic codes, noninvasive liver assessments.