Severe asymptomatic non-alcoholic fatty liver disease in routine diabetes care; a multi-disciplinary team approach to diagnosis and management

Armstrong, Matthew J.; Hazlehurst, Jonathan M.; Parker, Richard; Koushiappi, Elena; Mann, Jake; Khan, Sheeba; Philips, Angela; Chandler, Liz; Johnson, Jill; Round, Maria; Haydon, Geoffrey; Karamat, Mohammad A.; Newsome, Philip N.; Tomlinson, Jeremy W.
January 2014
QJM: An International Journal of Medicine;Jan2014, Vol. 107 Issue 1, p33
Academic Journal
Objectives: To prospectively use a non-invasive algorithm to identify asymptomatic, advanced non-alcoholic fatty liver disease (NAFLD) in a secondary care diabetes clinic and to determine the short-term effect of a multi-disciplinary team (MDT) approach in a liver clinic.Research design and methods: NAFLD Fibrosis Score (NFS) was calculated in 64 asymptomatic patients with type 2 diabetes. Advanced fibrosis was identified using transient elastography and confirmed with liver biopsy. In a subsequent retrospective study, 95 patients newly referred to the NAFLD MDT clinic were investigated and the impact of the MDT approach assessed.Results: 25/64 (39.0%) of patients with diabetes had a low NFS (<–1.455). 39/64 (61.0%) patients had a high or indeterminate NFS and were referred for review in the NAFLD MDT clinic, of which 23/39 attended for assessment. 19/23 (82.6%) were diagnosed with NAFLD, of which 6/19 (31.6%) patients had a positive transient elastography (≥8 kPa). Liver biopsy confirmed advanced fibrosis in 5/6 cases, with moderate fibrosis in 1 case.In the retrospective study, 65/95 (68.4%) new referrals to the NAFLD MDT clinic had a diagnosis of NAFLD. Over a median 98 days (IQR 70–182) follow-up, there was a significant improvement in weight (–0.8 kg; P = 0.024), total cholesterol (–0.2 mmol/L; P = 0.044), ALT (alanine transmaminase, −12.5 IU/L; P < 0.001) and GGT (gammu-glutamyl transferase, −13.0 IU/L; P < 0.0001). 7/28 (25%) of patients with diabetes achieved >5% weight loss.Conclusions: A significant proportion of asymptomatic patients attending type 2 diabetes clinics have undiagnosed advanced NAFLD fibrosis. An MDT approach to NAFLD results in short-term improvements in metabolic and liver parameters.


Related Articles

  • Efecto de la esteatosis hep�tica en el resultado de reconstrucci�n de v�a biliar por lesi�n iatrog�nica. Mercado-D�az, Miguel �ngel; Urencio-Marcu�, Miguel; Ram�rez-Del Val, Fernando; Dom�nguez-Rosado, Ismael // Cirugia y Cirujanos;mar/abr2010, Vol. 78 Issue 2, p145 

    No abstract available.

  • Gallstone Disease Does Not Predict Liver Histology in Nonalcoholic Fatty Liver Disease. Yilmaz, Yusuf; Ayyildiz, Talat; Akin, Hakan; Colak, Yasar; Senates, Ebubekir; Tuncer, Ilyas; Dolar, Enver // Gut & Liver;May2014, Vol. 8 Issue 3, p313 

    Background/Aims: We sought to examine whether the presence of gallstone disease (GD) in patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD) is associated with liver fibrosis and histological nonalcoholic steatohepatitis (NASH) score. Methods: We included 441 Turkish patients...

  • Anti-diabetes effect of water containing hydrogen molecule and Pt nanoparticles. Shirahata, Sanetaka; Hamasaki, Takeki; Haramaki, Keisuke; Nakamura, Takuro; Abe, Masumi; Yan, Hanxu; Kinjo, Tomoya; Nakamichi, Noboru; Kabayama, Shigeru; Teruya, Kiichiro // BMC Proceedings;2011 Supplement 8, Vol. 5 Issue Suppl 8, p1 

    An abstract of the article "Anti-diabetes effect of water containing hydrogen molecule and Pt nanoparticles," by Sanetaka Shirahata and colleagues is presented.

  • Changing geographical distribution of diabetes mellitus type 1 incidence in Austrian children 1989–2005. Waldhoer Thomas; Rami Birgit; Schober Edith // European Journal of Epidemiology;Mar2008, Vol. 23 Issue 3, p213 

    Abstract   Objectives We investigated whether the significant spatial West/East trend of incidence of Diabetes mellitus Type 1 in Austrian children changed between 1989 and 2005. Additionally we tested, whether population density and mean body mass index of newborns is associated...

  • No association of the IRS1 and PAX4 genes with type I diabetes. Bergholdt, R.; Brorsson, C.; Boehm, B.; Morahan, G.; Pociot, F. // Genes & Immunity;Dec2009 Supplement 1, Vol. 10, pS49 

    To reassess earlier suggested type I diabetes (T1D) associations of the insulin receptor substrate 1 (IRS1) and the paired domain 4 gene (PAX4) genes, the Type I Diabetes Genetics Consortium (T1DGC) evaluated single-nucleotide polymorphisms (SNPs) covering the two genomic regions. Sixteen SNPs...

  • Effect of Bitter Gourd (Momordica charantia) on Glycaemic Status in Streptozotocin Induced Diabetic Rats. A. Shetty; G. Kumar; K. Sambaiah; P. Salimath // Plant Foods for Human Nutrition;Sep2005, Vol. 60 Issue 3, p109 

    Abstract Bitter gourd (Momordica charantia), a commonly consumed vegetable is used as an adjunct in the management of diabetes mellitus. A study was carried out to examine the effect of edible portion of bitter gourd at 10% level in the diet in streptozotocin induced diabetic rats. To evaluate...

  • Tungstate administration improves the sexual and reproductive function in female rats with streptozotocin-induced diabetes. J. Ballester; M.C. Muñoz; J. Domínguez; M.J. Palomo; M. Rivera; T. Rigau; J.J. Guinovart; J.E. Rodríguez-Gil // Human Reproduction;Aug2007, Vol. 22 Issue 8, p2128 

    BACKGROUND Diabetes induces great alterations in female reproductive function. We analyzed the effects of tungstate, an anti-diabetic agent, on the reproductive function of healthy and diabetic female rats. METHODS Healthy and streptozotocin-induced diabetic rats were treated with sodium...

  • Adenosine signaling contributes to ethanol-induced fatty liver in mice. Zhongsheng Peng; Borea, Pier Andrea; Wilder, Tuere; Yee, Herman; Chiriboga, Luis; Blackburn, Michael R.; Azzena, Gianfranco; Resta, Giuseppe; Cronstein, Bruce N. // Journal of Clinical Investigation;Mar2009, Vol. 119 Issue 3, p582 

    Fatty liver is commonly associated with alcohol ingestion and abuse. While the molecular pathogenesis of these fatty changes is well understood, the biochemical and pharmacological mechanisms by which ethanol stimulates these molecular changes remain unknown. During ethanol metabolism, adenosine...

  • Acute Fatty Liver of Pregnancy. Duma, R.J.; Dowling, Edmund A.; Alexander, H.C.; Sibrans, Dyrc; Dempsey, Hugh // Annals of Internal Medicine;Nov65, Vol. 63 Issue 5, p851 

    Describes the case of patients who has recovered from acute fatty liver of pregnancy. Case history; Pathogenesis of acute fatty liver of pregnancy; Light and electron microscopic studies of serial liver biopsies; Regenerative changes associated with clinical recovery.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics