Interrelation of the Risk Factors of NAFLD at various Stages of Progression of the glycemic Status on long-term Follow-up

ABSTRACT

Background: Though the risk factors for nonalcoholic fatty liver disease (NAFLD) are the same in diabetic and nondiabetic patients, their exact interrelation and weightage in the pathogenesis are unclear. Methods: A total of 130 nondiabetic and 170 diabetic patients with NAFLD [diagnosed on abdominal ultrasound and severity assessed by NAFLD fibrosis score (NFS)] were recruited from 2009 to 2018 and their baseline risk factors [body mass index (BMI), waist circumference (WC), blood pressure, presence of the metabolic syndrome (MS) and insulin resistance (IR) by Homeostasis Model of Assessment for Insulin Resistance (HOMA-IR), fasting blood glucose (FBG) and lipid levels, and hemoglobin A1c (HbA1c) levels] were noted and their interrelationship studied. The nondiabetic patients were prospectively followed up for alteration of glycemic status. Results: There was presence of high BMI (>23) in 66%, central obesity in 86% (of whom 59% had normal body weight), low high-density lipoprotein cholesterol (HDL) in 51%, high triglyceride (TG) in 68%, high low-density lipoprotein cholesterol (LDL) in 46.7%, IR in 86%, hypertension in 54%, and the MS in 57%. Hemoglobin A1c was high in 42.3% of nondiabetics. The prevalence of the MS was significantly higher in patients having IR and vice versa but only the MS and its components as also increasing age determined advanced fibrosis. After mean follow-up 7.3 years, progression from prediabetes (PD) to diabetes mellitus (DM) occurred in 10%, from normal glucose tolerance (NGT) to PD in 6.25%, and progression of NFS occurred in 16.9%. Advanced age, low HDL and high TG were associated with IR and were involved in glycemic progression as also obesity in progression from NGT to PD and central obesity from PD to DM. Conclusion: Though IR and MS go hand in hand in the pathogenesis of NAFLD in both diabetic and nondiabetic patients as well as in the glycemic progression of nondiabetic patients with NAFLD, the MS or its components have more weightage in determining the severity