Arch Iran Med. 2021;24(3): 177-186.
doi: 10.34172/aim.2021.28

Scopus ID: 85105029047
  Abstract View: 1376
  PDF Download: 758

Original Article

Hepatic Steatosis and Fibrosis in Type 2 Diabetes: A Risk-Based Approach to Targeted Screening

Hossein Poustchi 1, Fariba Alaei-Shahmiri 2, Rokhsareh Aghili 2, Sohrab Nobarani 2, Mojtaba Malek 3, Mohammad E. Khamseh 2*

1 Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
3 Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
*Corresponding Author: *Corresponding Author: Mohammad E. Khamseh, MD; No. 10, Firoozeh St., South Vali-asr Ave., Vali-asr Sq., Tehran, Iran. Tel: +98-21-88945172; Fax: +98-21- 88945173, Email: , Email: khamseh.m@iums.ac.ir


Background: Non-alcoholic fatty liver disease (NAFLD) is common in people with type 2 diabetes mellitus (T2DM). We aimed to explore predictive factors of NAFLD in T2DM and identify high risk subgroups.
Methods: This was a cross-sectional study including 100 individuals with T2DM and 100 without diabetes matched for age, sex, and body mass index (BMI). Hepatic steatosis grades (calculated by controlled attenuation parameters-CAP score-3), and liver fibrosis stages (F0-F4) were determined using transient elastography.
Results: The frequency of NAFLD was comparable between the two study groups. However, CAP scores were significantly higher in individuals with diabetes (294.90 ± 53.12 vs. 269.78 ± 45.05 dB/m; P < 0.001). Fifty percent of individuals with diabetes had severe steatosis (S3), while this figure was 31.6% in those without diabetes (P < 0.05). Significant fibrosis (F2-F4) was more frequent in individuals with T2DM (13% vs. 4.1%, P = 0.02). Individuals with T2DM and advanced fibrosis had significantly higher BMI, waist circumference (WC), waist-hip ratio (WHR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and CAP score compared to those without fibrosis (P < 0.05). In the regression analysis, a model including BMI, WHR, AST and female gender explained 50% of the variation in CAP score in patients with diabetes (all P < 0.05, adjusted R2 : 0.508). CAP scores were also the major determinant of liver fibrosis in this group (OR: 1.04; CI: 1.017–1.063; P = 0.001).
Conclusion: Individuals with diabetes are more likely to have severe fibrosis. Obesity (especially central obesity), the female gender, elevated liver enzymes, and higher degree of insulin resistance are associated with more advanced liver disease in individuals with T2DM.

Cite this article as: Poustchi H, Alaei-Shahmiri F, Aghili R, Nobarani S, Malek M, Khamseh ME. Hepatic steatosis and fibrosis in type 2 diabetes: a risk-based approach to targeted screening. Arch Iran Med. 2021;24(3):177–186. doi: 10.34172/aim.2021.28.
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Submitted: 20 Apr 2020
Accepted: 19 Oct 2020
ePublished: 01 Mar 2021
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