The Association Between Risk Factors And Ultrasound-Based Grades Of Non-Alcoholic Fatty Liver Disease In Type-2 Diabetes Patients

Background: Non-alcoholic fatty liver disease (NAFLD) has become more common as the cause of cirrhosis and liver cancer. The liver disease is highly prevalent in people with type-2 diabetes. Indonesia is not spared from the global epidemic of type-2 diabetes. The ultrasound examination is clinically easy-to-use, economical and non-invasive as a tool to detect NAFLD, compared to the gold standard, liver biopsy. To date, there has been no study in Indonesia to link risk factors and ultrasound-based severity grading of NAFLD. Aim: To understand the association between risk factors and ultrasound-based grades of NAFLD in patients with type-2 diabetes. Method: The present study was an observational study with a cross-sectional design (May-October 2018) that involved 82 type-2 diabetes outpatients of the internal medicine clinic in the Gotong Royong Hospital (Surabaya, Indonesia). The risk factors assessed were gender, age, diabetes duration, obesity (anthropometric measurement: body mass index/ BMI, waist circumference and waist-to-hip ratio), glycemic control (hemoglobin A1c/ HbA1c level) and dyslipidemia (lipid profile: total cholesterol, low-density lipoprotein/ LDL, high-density lipoprotein/ HDL and triglyceride). The ultrasound-based grades of NAFLD consisted of grade 0 (no NAFLD), grade 1 (increased liver echogenicity with normal images of intrahepatic vessel lines and diaphragm), grade 2 (blurred image of intrahepatic vessel lines) and grade 3 (blurred images of intrahepatic vessel lines and diaphragm). Statistical p-value was significant at ≤ 0.05. Results: Seventy-eight subjects (95,1%) had NAFLD. The ultrasound-based NAFLD grades were significantly different across age groups (Kruskal-Wallis) but the Spearman’s rank correlation test result was not significant. Body mass index and total cholesterol were positively correlated (r = 0.390 and 0.237, respectively) with the NAFLD grades. Conclusion: Higher BMI and total cholesterol are associated with increased ultrasound-based NAFLD grades.