Sunday, August 12, 2012

Diabetes, family history of diabetes associated with NASH, fibrosis in NAFLD patients

Diabetes, family history of diabetes associated with NASH, fibrosis in NAFLD patients

Loomba R. Hepatology. 2012;doi:10.1002/hep.25772.

Patients with nonalcoholic fatty liver disease who had either diabetes or a family history for the illness were at an increased risk for developing nonalcoholic steatohepatitis and fibrosis in a recent study.

In a cross-sectional analysis, researchers evaluated data from 1,069 patients with nonalcoholic fatty liver disease (NAFLD) enrolled in either the NAFLD Database study or the PIVENS trial between October 2004 and February 2008. Diabetes status was determined through interviews and chart reviews.

Diabetes was present in 30.4% of participants, with a first-degree family history of diabetes in 56% of the cohort. After adjusting for confounders including age, sex, BMI and ethnicity, diabetes was associated with nonalcoholic steatohepatitis (NASH) (OR=1.76; 95% CI, 1.13-2.72) and fibrosis (OR=2.57; 95% CI, 1.61-4.11), as was family history of diabetes (OR=1.34; 95% CI, 0.99-1.81 for NASH and OR=1.38; 95% CI, 1.02-1.87 for fibrosis). Patients with diabetes were found more likely to develop advanced fibrosis (adjusted OR=2.39; 95% CI, 1.68-3.14), but those with a family history were not (adjusted OR=0.92; 95% CI, 0.69-1.24).

When patients with diabetes were excluded from analysis, a family history of diabetes was associated with NASH (adjusted OR=1.51; 95% CI, 1.01-2.25) and the presence of fibrosis (adjusted OR=1.49; 95% CI, 1.10-2.20).

Patients with a personal and family history for diabetes were at greater risk for NASH (OR=2.13; 95% CI, 1.38-3.30), fibrosis (OR=3.43; 95% CI, 2.11-5.56) and advanced fibrosis (OR=4.76; 95% CI, 2.96-7.64). No interaction was found, however, between personal and family diabetes history in predicting NASH (P=.24), fibrosis (P=.58) or advanced fibrosis (P=.13).

“Family history of diabetes and personal history of diabetes both independent of each other increase the risk of advanced liver disease in patients with NAFLD,” Rohit Loomba, MD, MHSc, assistant professor of clinical medicine in the gastroenterology division at the University of California, San Diego, told “This paper illustrates the value of family history in risk stratification of patients with NAFLD and who might be considered for liver biopsy assessment.”

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