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Significant fibrosis predicts new-onset diabetes mellitus and arterial hypertension in patients with NASH

AuthorsAmpuero, Javier; Aller, Rocío; Gallego-Durán, Rocío; Crespo García, Javier; Calleja, José Luis; García-Monzón, Carmelo; Gómez-Camarero, Judith; Caballería, Juan; Lo lacono, Oreste; Ibáñez, Luis; García-Samaniego, Javier; Albillos, Agustín; Francés, Rubén; Fernández-Rodríguez, Conrado M.; Diago, Moisés; Soriano, Germán; Andrade, Raúl J.; Latorre, Raquel; Jorquera, Francisco; Morillas, Rosa María; Escudero, Desamparados; Estévez, Pamela; Hernández-Guerra, Manuel; Augustín, Salvador; Banales, Jesus M.; Aspichueta, Patricia; Benlloch, Salvador; Rosales-Zábal, José Miguel; Salmerón, Javier; Turnes, Juan; Romero-Gómez, Manuel
Hepamet score
Diabetes mellitus
Arterial hypertension
Issue DateJul-2020
CitationJournal of Hepatology 73(1): 17-25 (2020)
Abstract[Background & Aims] Non-alcoholic fatty liver disease (NAFLD) could play a catalytic role in the development of metabolic comorbidities, although the magnitude of this effect in metabolically healthy patients with NAFLD remains unclear. We assessed the role of biopsy-proven NAFLD on the risk of developing type 2 diabetes mellitus (T2DM) and other metabolic comorbidities (arterial hypertension [AHT], and dyslipidemia) in metabolically healthy patients.
[Methods] We included 178 metabolically healthy—defined by the absence of baseline T2DM, AHT, dyslipidemia—patients with biopsy-proven NAFLD from the HEPAmet Registry (N = 1,030). Hepamet fibrosis score (HFS), NAFLD fibrosis score, and Fibrosis-4 were calculated. Follow-up was computed from biopsy to the diagnosis of T2DM, AHT, or dyslipidemia.
[Results] During a follow-up of 5.6 ± 4.4 years, T2DM occurred in 9% (16/178), AHT in 8.4% (15/178), low HDL in 9.6% (17/178), and hypertriglyceridemia in 23.6% (42/178) of patients. In multivariate analysis, significant fibrosis predicted T2DM and AHT. Independent variables related to T2DM appearance were significant fibrosis (HR 2.95; 95% CI 1.19–7.31; p = 0.019), glucose levels (p = 0.008), age (p = 0.007) and BMI (p = 0.039). AHT was independently linked to significant fibrosis (HR 2.39; 95% CI 1.14–5.10; p = 0.028), age (p = 0.0001), BMI (p = 0.006), glucose (p = 0.021) and platelets (p = 0.050). The annual incidence rate of T2DM was higher in patients with significant fibrosis (4.4 vs. 1.2 cases per 100 person-years), and increased in the presence of obesity, similar to AHT (4.6 vs. 1.1 cases per 100 person-years). HFS >0.12 predicted the risk of T2DM (25% [4/16] vs. HFS <0.12 4.5% [4/88]; logRank 6.658, p = 0.010).
[Conclusion] Metabolically healthy patients with NAFLD-related significant fibrosis were at greater risk of developing T2DM and AHT. HFS >0.12, but not NAFLD fibrosis score or Fibrosis-4, predicted the occurrence of T2DM.
[Lay summary] Patients with biopsy-proven non-alcoholic fatty liver disease and significant fibrosis were at risk of developing type 2 diabetes mellitus and arterial hypertension. The risk of metabolic outcomes in patients with significant fibrosis was increased in the presence of obesity. In addition to liver biopsy, patients at intermediate-to-high risk of significant fibrosis by Hepamet fibrosis score were at risk of type 2 diabetes mellitus.
Publisher version (URL)http://dx.doi.org/10.1016/j.jhep.2020.02.028
Identifiersdoi: 10.1016/j.jhep.2020.02.028
issn: 0168-8278
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