Mushfiq Syed, Yatoo Ghulam Nabi, Mir Bilal Ahmad, Rasool Zubaida
Department of Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar J and K, India.
Department of Gastroenterology, IGMC, Shimla, Himachal Pradesh, India.
J Family Med Prim Care. 2025 Jan;14(1):56-61. doi: 10.4103/jfmpc.jfmpc_1208_23. Epub 2025 Jan 13.
Non-alcohol fatty liver disease (NAFLD) is a metabolic disorder that represents the hepatic manifestation of systemic process, and is a strong risk factor for diabetes Meletus, whereas the presence of DM increases the severity of NAFLD/NASH and its progression. Data on the impact of diabetes on NASH phenotype is sparse from northern India. We studied and compared the clinical profile of NALFD in the presence and absence of DM and the effect of diabetes on NASH.
We did a cross-sectional analysis of data from NAFLD patients (n = 90) who were divided into diabetic and non-diabetic cohorts and their respective demographic, biochemical, imaging and histological features were recorded and compared.
Out of 90 patients, 53.3% were females with a mean age of 44 ± 12 years. The mean BMI and WHR of the study cohort were 28.9 ± 3.4 and 1.01 ± 0.15, respectively. The current study showed that 35.8% were diabetics. The mean age and WHR were 52 ± 11 years vs 40 ± 10 years and 1.1 ± 0.17 vs 0.99 ± 0.09, respectively, in diabetic and non-diabetic NAFLD patients. Non-invasive fibrosis scores, including BARD (2.8 vs 1.73), FIB-4 (3.4 vs 2.2) and NFS (0.97 vs -1.13), were significantly higher in diabetic NAFLD compared to non-diabetic NAFLD ( < 0.03). The histological grade of steatosis and fibrosis as depicted by the mean NAS score (5.7 ± 1.2 vs 4.63 ± 0.8) was higher in diabetic NAFLD vs non-diabetic NAFLD; however, only the fibrosis stage was statistically significant between the groups ( < 0.001).
Despite the small no of cases, we should conclude that there is a bidirectional relationship between NAFLD and DM where the progression of one increases the rate of progression of other. Diabetic patients have higher risk of NASH and hence increased risk of liver related mortality and should be screened early for NAFLD/NASH.
非酒精性脂肪性肝病（NAFLD）是一种代谢紊乱疾病，代表着全身代谢过程的肝脏表现，是糖尿病的一个重要危险因素，而糖尿病的存在会增加NAFLD/NASH的严重程度及其进展。来自印度北部关于糖尿病对NASH表型影响的数据较少。我们研究并比较了合并和未合并糖尿病时NAFLD的临床特征以及糖尿病对NASH的影响。
我们对NAFLD患者（n = 90）的数据进行了横断面分析，将患者分为糖尿病组和非糖尿病组，并记录和比较了他们各自的人口统计学、生化、影像学和组织学特征。
90例患者中，53.3%为女性，平均年龄为44±12岁。研究队列的平均BMI和WHR分别为28.9±3.4和1.01±0.15。本研究显示，35.8%为糖尿病患者。糖尿病和非糖尿病NAFLD患者的平均年龄分别为52±11岁和40±10岁，WHR分别为1.1±0.17和0.99±0.09。与非糖尿病NAFLD相比，糖尿病NAFLD患者的非侵入性纤维化评分，包括BARD（2.8对1.73）、FIB-4（3.4对2.2）和NFS（0.97对-1.13）显著更高（<0.03）。糖尿病NAFLD患者的平均NAS评分所显示的脂肪变性和纤维化组织学分级（5.7±1.2对4.63±0.8）高于非糖尿病NAFLD患者；然而，两组之间只有纤维化阶段具有统计学意义（<0.001）。
尽管病例数较少，但我们可以得出结论，NAFLD和糖尿病之间存在双向关系，其中一方的进展会增加另一方的进展速度。糖尿病患者发生NASH的风险更高，因此肝脏相关死亡率风险增加，应尽早筛查NAFLD/NASH。
