NON-ALCOHOLIC FATTY LIVER DISEASE AND RELATIONSHIP WITH ADIPOSITY IN NIGERIAN PATIENTS WITH TYPE 2 DIABETES MELLITUS: THE IBADAN EXPERIENCE.

Abstract

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is the commonest cause of chronic liver disease and is frequently found in patients with Type 2 diabetes (T2D). NAFLD is associated with excess adiposity and prevalence could vary by BMI sub-groups. There remain conflicting reports about the prevalence of NAFLD in T2D in Africa, particularly Nigeria. We studied the prevalence of NAFLD and its relationship to adiposity in a cohort of persons living with T2D.

Methodology: A cross-sectional study of 147 consecutive T2D patients, attending the Diabetes Clinic, at the University College Hospital, Ibadan, was conducted over a period of two months. Clinical history and anthropometric indices were obtained; in addition, blood samples were taken and analyzed for FBS, HbA1c, Fasting Lipids Profile, HBsAg, Anti HCV, ALT, AST, ALP, GGT and albumin. Hepatic ultrasound was conducted by an experienced sonologist. Data were collected with the aid of a pre-tested semi-quantitative questionnaire and were analysed using the SPSS software 15.0 version.

Results: Prevalence of NAFLD in persons living with T2D in 139 participants with complete data was 46% with a mean (SD) BMI of 27.4 (5.6). The participants with NAFLD had significantly excess adiposity, particularly the obese subgroup compared to those without [32 (50.0%) and 5 (6.7%), p = 0.001], respectively. Factors associated with NAFLD include female sex, older age, increased BMI, increased waist circumference, raised serum triglycerides, higher HbA1c levels, and raised alkaline phosphate levels. Sex, BMI, waist circumference and serum ALP were independently associated with NAFLD. Of notable interest is the raised serum ALP levels in subjects with NAFLD compared to those without NAFLD: mean (SD) = 30.6 (16.5) and 23.7 (15.3), respectively (p = 0.020).

Conclusion: NAFLD is relatively common in patients living with type 2 diabetes and is associated with excess adiposity and increased alkaline phosphatase. Dietary and lifestyle changes can play a pivotal role in reducing prevalence of these diseases. Further, ALP could be a useful marker to assess the progression of NAFLD.