BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is prevalent in patients with Type 2 Diabetes Mellitus (T2DM) and is associated with chronic kidney disease (CKD). The aim of this cross-sectional study was to determine the association of Fibrosis-4 (FIB-4) index with CKD among T2DM patients with concomitant NAFLD.

METHODOLOGY

A single center, analytical cross-sectional study was conducted among 216 T2DM patients with concomitant NAFLD. Clinical data were obtained via retrospective review of medical charts. The outcome of interest was CKD which was based on self-report obtained from medical charts or estimated Glomerular Filtration Rate (eGFR) < 60mL/min result nearest to the date of liver ultrasound. FIB-4 index of patient on admission was calculated using an online calculator and subjects were grouped into low, moderate and high risk of developing severe fibrosis depending on their FIB-4 index. In order to determine the association between FIB-4 index and CKD, logistic regression analysis was performed.

RESULTS

Higher FIB-4 index was found to be significantly associated with CKD. Patients with FIB-4 index of 1.45-3.25 (moderate risk) and > 3.25 (high risk) have about 3 times higher odds of CKD. However, after controlling for the significant confounders, only those who belong to high-risk group was found to be associated with CKD.

CONCLUSION

This study has demonstrated that FIB4 index > 3.25, an index of liver fibrosis, is significantly associated with development of CKD in T2DM patients with concomitant NAFLD.

Human ; Diabetes Mellitus ; Non-alcoholic Fatty Liver Disease ; Chronic Kidney Diseases ; Renal Insufficiency, Chronic

The non-structural 5B (NS5B) gene is the target region to identify hepatitis C virus (HCV) subtypes. However, it is not always possible to amplify this region because of inherently high sequence variability. Nucleotide sequences of the non-structural 5A (NS5A) and NS5B genes and its concordance were determined from patients infected with HCV genotype 1 (HCV-1). Among the 30 HCV-1 samples, 7 (23%) were identified as subtype 1a and 23 (77%) were identified as 1b by NS5A sequencing. Sequence analysis of the NS5B showed that 13 (43%) were identified as 1a and 17 (57%) were identified as 1b. Out of the 13 samples identified as 1a by NS5B, 6 (46%) were correctly identified by NS5A. Of the 17 samples identified as 1b by NS5B, 16 (94%) were correctly identified by NS5A. The presence of glutamic acid (E) or aspartic acid (D) at position 2225 in the NS5A differentiates 1a from 1b subtypes, respectively. This study showed that the NS5A sequencing can identify HCV-1a and 1b subtypes with predictive values of 86% and 70% of cases, respectively. The overall concordance with NS5B was 73%. NS5B sequence analysis remains to be the reference method to identify HCV-1 subtypes. NS5A sequencing may be used to complement NS5B sequencing in case the NS5B gene cannot be successfully amplified.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; ; Aspartic Acid ; Genotype ; Glutamic Acid ; Hepacivirus ; Hepatitis C ; Nucleotides ; Sequence Analysis ; Viral Nonstructural Proteins

BACKGROUND: Non-alcoholic Fatty Liver Disease (NAFLD) includes a spectrum of liver damage, ranging from simple, bland steatosis, which is usually associated with a benign prognosis, to nonalcoholic steatohepatitis (NASH), which has the potential to progress to cirrhosis and its inherent complications of liver failure and liver cancer. It is reported to be prevalent among patients with Type 2 Diabetes Mellitus.

OBJECTIVES: (1) To determine the association of the risk factors in the development of non-alcoholic fatty liver disease, in Filipino patients with Type 2 Diabetes Mellitus; (2) To assess the correlation between the severity of ultrasonographic hepatic steatosis and degree of glucose control, dyslipidemia and obesity; (3) To observe the hepatic markers particularly the transaminases in patients with Type 2 diabetes mellitus with obesity and or dyslipidemia.

METHODS: One hundred forty se-ven diagnosed Type 2 diabetes without history of alcohol intake >30g/week in men and 20g/week in women underwent history and physical examination and anthropometric measurements. BMI was used to estimate overall adiposity. Fasting blood samples were collected for measurement of liver function (GGT, ALT, AST, CHON, Bilimbin, ALP), and hepatitis profile (HBsAg, Anti-HBs, Anti-HCV) to note those with concurrent liver diseases. Lipid profile, were also obtained to identify diabetic patients with dyslipidemia; fasting blood sugar, and HbAlc defined the glycemic control in its relation to the presence of probable NAFLD. All subjects underwent ultrasonography of the liver using one ultrasound machine, performed by one radio-technologist, and read by only one sonologist. Presence of fatty liver was noted and reported as mild, moderate and severe.

RESULTS: Features of NAFLD seen in the subjects in this study include absence of symptoms referable to the liver, elevated transaminases ( ALT at 15 percent, AST at 13 percent, with ALT/AST > lat 12 percent) and with features of metabolic syndrome. Statistatically, there is no association of the ALT/ AST > 1 (probable NAFLD) among the Type 2 DM subjects with dyslipidemia, obesity and metabolic syndrome. Sonographic NAFLD, however, showed that there is a significant association of fatty liver and obesity at 69% with a p value of

CONCLUSION: There is a close link of hepatic steatosis to T2DM patients who are obese. Elevated ALT was correlated in the development of fatty liver. Type 2 Diabetes Mellitus associated with NAFLD has the potential to progress to cirrhosis and its inherent complications of liver failure and liver cancer and thus make an important endocrine health problem. (Author)

Diabetes Mellitus, Type 2