Severe asymptomatic non-alcoholic fatty liver disease in routine diabetes care; a multi-disciplinary team approach to diagnosis and management.
نویسندگان
چکیده
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.
منابع مشابه
A diagnostic model for cirrhosis in patients with non-alcoholic fatty liver disease: an artificial neural network approach
Background :Timely diagnosis of liver cirrhosis is vital for preventing further liver damage and giving the patient the chance of transplantation. Although biopsy of the liver is the gold standard for cirrhosis assessment, it has some risks and limitations and this has led to the development of new noninvasive methods to determine the stage and prognosis of the patients. We aimed to design an...
متن کاملAssociation of Non-Alcoholic Fatty Liver Dis-ease and Diabetic Retinopathy in Patients with Type 2 Diabetes Mellitus: a Cross-Sectional Study
Background: Diabetic retinopathy is a common chronic complication of diabetes and one of the leading causes of acquired blindness in the world. There is growing evidence that traditional risk factors do not fully justify the onset and progression of diabetic retinopathy. Therefore, some other risk factors such as non-alcoholic fatty liver disease may be involved in the pathophysiology of diabe...
متن کاملAssociation of Dietary Phytochemical Index and Anthropometric Risk Factors with Non-alcoholic Fatty Liver Disease in People with Diabetes
Background and Objectives: High prevalence of non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus results in deleterious complications and morbidities. Therefore, the aim of this study was to assess nutritional and anthropometrical risk factors in progression of non-alcoholic fatty liver disease in diabetic patients. Materials & Methods: Totally, 133 non-alcoholic fatty...
متن کاملHow is the Effect of Physical Activity on Non-Alcoholic Fatty Liver in Obese People? A Mini Review
Nonalcoholic fatty liver is known in the general public as an epidemic disease. The purpose of this mini-review was to determine a link between physical education (PA) and the risk of nonalcoholic fatty liver disease (NAFLD) determine the influence of an exercise method (volume and kind of exercise) on being health outcome. Body mass index (BMI) was the good criteria for classifying obesity. I...
متن کاملClinical Manifestations and Diagnosis of Non-Alcoholic Fatty Liver Disease
Background & Objective: Nonalcoholic fatty liver diseases (NAFLD) is the major cause of hepatocellular carcinoma and increases the risk of mortality. Understanding the trends of its clinical and biochemical changes is essential to identify patients with NAFLD that are at the greatest risk of nonalcoholic steatohepatitis (NASH) and cirrhosis in Iran. M...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- QJM : monthly journal of the Association of Physicians
دوره 107 1 شماره
صفحات -
تاریخ انتشار 2014