Background

Non-alcoholic fatty liver (NAFL) is one of the most common causes of morbidity and mortality. Diabetes and NAFLD commonly co-exist, affect the development of each other, and act synergistically to cause catastrophic health consequences. The early stages of NAFLD are easily reversible. Therefore, experts recommend screening for NAFLD in Type 2 diabetes mellitus (T2DM) patients and some other high-risk populations. Diabetes is a significant health issue in Palestine. This study aimed to characterize the factors associated with the development of NAFLD in T2DM Palestinian diabetic patients in Nablus-Palestine to decrease the burden of liver diseases and the risk of hyperglycemic complications among them.

Methods

This cross-sectional study was done in 2022. Adult patients [n=539] who were previously diagnosed with T2DM and presented to primary health care clinics in Nablus-Palestine for follow-up routine tests were recruited. A scoring system calculated gender-based hepatic steatosis index (HSI) was used. A score <30 rules out NAFLD, and ≥3,6 indicates that NAFLD is likely to present, and 30-36 is inconclusive. B-mode ultrasound was used to diagnose fatty liver steatosis (FLS) as mild, moderate and severe FLS. A face-to-face interview was conducted and medical reports were also used.  Ethical approval was obtained from Institute Review Board and written informed consent was obtained from all participants. Adjusted multiple logistic regression analysis evaluated the relative risk by generating the odds ratios (OR) and 95% confidence intervals for risk factors. A p-value of less than 0.05 was considered statistically significant.

Findings: 429 [83.0%] agreed to participate, 29 withdrew, and 224[56.1%] were males. The mean age±SD was 56.1±10.4 years. Based on the HSI score, 364[91.2%] had HIS score ≥36 and 36(8.8%] with HSI score 32-<36. Based on B-mode ultrasound diagnosis, 135[33.8%] patients were diagnosed with mild-FLS, 1689[42.1%] with moderate-FLS, and 15[3.8%] with severe-FLS. Compared to patients diagnosed free of  FLS, patients with severe FLS were significantly at higher risk of increased cholesterol levels (OR=1.047), HSI (OR=1.32), and diabetic retinopathy (OR=7.074). In comparison, patients with moderate FLS were at higher risk of increased cholesterol levels (OR=1.023), HbA1c (OR=1.06), HSI (OR=1.21), and age (OR=1.071). Moreover, patients with mild FLS were at higher risk of increased cholesterol levels (OR=1.02), HbA1c (OR=1.312), HSI (OR=1.102), and age (OR=1.047). Decreasing LDL levels were associated with decreased risk of mild (OR=0.982), moderate (OR=0.97), and severe (OR=0.955) FLS. Diabetes treatment regimen, the number of years diagnosed with diabetes, hypertension, high-density lipoprotein levels, and triglycerides levels were not associated with FLS.

Interpretation: NAFLD is high among T2DM in Nablus-Palestine and higher than global levels. This research could have clinical implications. It could recommend a screening program for the early detection of NAFLD among diabetics using ultrasound to reduce NAFLD and its complications among them.

Conference Title

The 12th LPHA Conference

Conference Country

Palestine

Conference Date

Nov. 21, 2022 - Nov. 23, 2022

Conference Sponsor

Lancet

Additional Info

Conference Website