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Diabetes and Fatty Liver Associated with Further Liver Problems

Sep 4, 2015

Adding liver fibrosis to the long list of diabetic complications under consideration…

A recent study published in Hepatology evaluated various risk factors for liver fibrosis in a Dutch population. The call for concern is the prevalence of liver fibrosis in a patient population with low prevalence of hepatitis—the usual suspect of causation.


Some links have shown non-alcoholic liver disease has a connection to liver fibrosis. Certainly, identifying modifiable risk factors and their impact in developing liver problems can be important to targeting change.

The prospective cohort study was conducted over two years in Rotterdam on 3,041 patients, 45 years or older. Abdominal ultrasounds were used to scan their livers and evaluate liver stiffness to characterize potential fibrosis. Further collections of blood, anthropometric measures, medical history, demographics, drug use, alcohol consumption, smoking history and comorbidities were evaluated.

Just over one-third (35.5%) of the patients had the presence of fatty liver and 5.6% of the patients had a liver stiffness over 8 kPa or clinically relevant for liver fibrosis. Not surprisingly, having the presence of positive surface antigens for hepatitis B or C resulted in a five-fold increased chance in also having liver fibrosis.

More surprisingly, having both diabetes and a fatty liver also had a five-fold increased chance in also having liver fibrosis. This is among one of the first studies to measure the impact of diabetes and non-alcoholic fatty liver on further liver problems.

The problem could be even worse in the United States where the population has a higher prevalence of diabetes and fatty liver disease than the Dutch population used in this research. How the presence of liver fibrosis can lead to cirrhosis or liver cancer for these patients remains to be explored.

Practice Pearls:

  • A study of 3,041 Dutch patients evaluated the presence of various risk factors and liver fibrosis diagnosed via ultrasound.
  • Both antigen positive Hepatitis B and C and having diabetes and a fatty liver showed a fivefold increase in the likelihood of also having liver fibrosis.
  • Having both diabetes and fatty liver disease could result in long-term liver damage for patients, but more research needs to be conducted to evaluate this risk.

Koehler, Edith M., Elisabeth P.c. Plompen, Jeoffrey N.l. et al. “Presence of Diabetes Mellitus and Steatosis Is Associated with Liver Stiffness in a General Population.” Hepatology (2015). Web.