title: Nonalcoholic fatty liver disease (NAFLD) in nonobese patients with diabetes: Prevalence and relationships with hemodynamic alterations detected with Doppler sonography().
abstract: OBJECTIVE
  To evaluate the prevalence, severity, and hemodynamic features of nonalcoholic fatty liver disease (NAFLD) in nonobese diabetics.
  
  
  METHODS
  We studied 100 consecutive nonobese (body mass index [BMI] < 30) patients with type 1 (n = 17) or type 2 (n = 83) diabetes and no known causes of liver disease. Steatosis was diagnosed and graded with ultrasonography. Digital sonographic images of the liver and right kidney were analyzed with dedicated software (HDI-Lab), and the liver/kidney ratio of grey-scale intensity was calculated as an index of the severity of the steatosis. Severity scores ranging from 0 (none) to 5 (severe) were compared with sonographic and Doppler findings (right liver size, portal vein diameter and flow velocity, hepatic and splenic arterial pulsatility indices, hepatic-vein flow profile and A- and S-wave velocities).
  
  
  RESULTS
  The prevalence of steatosis was 24% in type I and 80% in type II diabetes (grade 1 in 17%, grade 2 in 34%, grade 3 in 33%, grade 4 in 9%, grade 5 in 7%). In patients with steatosis (especially those with grades 4-5 disease), hepatic volume was increased (p < 0.005). Portal vein diameter was increased in grade 5 steatosis. The hepatic artery pulsatility index was significantly increased, particularly in grades 4 and 5 (p < 0.0001); portal and A-wave velocities were significantly reduced in grades 3-5 (p < 0.001); and the hepatic vein flow profile was altered in 27% (biphasic: 20%, flat: 7%) patients with steatosis, although there was no correlation with severity.
  
  
  CONCLUSIONS
  NAFLD is very frequent in nonobese diabetics with type 2 but not type 1 disease, and it is associated with hepatomegaly and liver hemodynamic alterations only when it is severe.
authors: Clinica Medica 5, Department of Clinical and Experimental Medicine, University of Padua, Italy.
authors: S
authors: S
authors: Gaiani
authors: A
authors: A
authors: Avogaro
authors: G C
authors: GC
authors: Bombonato
authors: M
authors: M
authors: Bolognesi
authors: F
authors: F
authors: Amor
authors: S
authors: S
authors: Vigili de Kreutzenberg
authors: G
authors: G
authors: Guarneri
authors: D
authors: D
authors: Sacerdoti
keywords: Diabetes; Doppler; NAFLD; Sonography; Splanchnic hemodynamics; Steatosis
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