A prospective cross sectional study to determine the prevalence of nonalcoholic Steatohepatitis in adults with type 2 diabetes In an urban region of northwest India

Abstract

Background: Type 2 diabetes (T2D) and nonalcoholic steatohepatitis (NASH) are newlinestrongly correlated and independently increase the risk of cardiovascular disease newline(CVD). The current prevalence of NASH and significant risk factors in Indian newlinepatients with T2D is not known because of limitations in the methods of diagnosis of newlineNASH. Primary Aim: Determine the prevalence of NASH in a cohort of adults newlinewith type 2 diabetes. Secondary Aims: Identify significant risk factors and gender newlinedifferences, and evaluate the correlation of NASH with arterial stiffness (AS) in newlineT2D subjects. Materials and Methods: Approval from the Institutional Ethics newlineCommittee and informed consent of the participating patients were obtained. NASH newlinewas diagnosed by Transient Elastography with FibroScan when liver stiffness newlinemeasurement (LSM) was and#8805;7 kPa and NAFLD Fibrosis Score (NFS) was gt0.675. AS newlinewas measure by Aortic Pulse Wave Velocity (aPWV) with the PW Analyzer. newlineResults: NASH with significant fibrosis was present in 30% of the cohort of 613 newlineadults with T2D (35% women, 26% men). NASH existed in 78.1% women and newline61.4% men with SGPT below 40 IU/L. Multivariate analysis showed that Age, newlineWaist Circumference (WC), SBP, HbA1c, SGOT, SGGT, serum Albumin, total newlineCholesterol, Platelet count, NAFLD Fibrosis score and AS were independent newlinepredictors of NASH. The significant predictors of AS were age, hypertension, liver newlinestiffness, low platelet count and low serum albumin. The waist-to-height ratio was newlinethe most sensitive parameter of obesity. Gender differences were observed for both newlineNASH and AS. A negative correlation of serum albumin and platelet counts was newlineseen for both NASH and arterial stiffness. The association of LSM and AS was newlinemutually detrimental. The NAFLD Fibrosis score significantly correlated with LSM. newlineConclusions: The absence of elevated SGPT above 40 IU/L should not deter newlinephysicians from considering a diagnosis of NASH in patients with T2D. Liver newlinefibrosis and arterial stiffness were significantly associated with each other in a newlinemutually detrimental man