title: Non-alcoholic fatty liver disease in diabetics--prevalence and predictive factors in a multiracial hospital clinic population in Malaysia.
abstract: OBJECTIVE
  There is currently no published study comparing prevalence of non-alcoholic fatty liver disease (NAFLD) and associated factors among diabetics of different ethnicity in the Asia-Pacific region.
  
  
  METHODS
  Cross-sectional study of consecutive patients in the Diabetic Clinic in University of Malaya Medical Centre. The Global Physical Activity Questionnaire and a semiquantitative food-frequency questionnaire were used to assess physical activity and dietary intake, respectively. Diagnosis of NAFLD was ultrasound-based and following exclusion of significant alcohol intake.
  
  
  RESULTS
  Data for 399 patients were analyzed (mean age 62.3 ± 10.5 years, 43.1% men). The racial distribution was Chinese 43.6%, Indian 33.1%, Malay 22.3%, and others 1.0%. The prevalence of NAFLD was 49.6%. On univariate analysis, factors associated with NAFLD were age < 65 years, race, obesity, central obesity, glycated hemoglobin ≥ 7.0%, and elevated serum alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase levels. Patients with low physical activity were more likely to have NAFLD (odds ratio [OR] = 1.67, 95% confidence interval [CI] = 1.06-2.63, P = 0.020). The prevalence of NAFLD was highest among Malays (60.7%), followed by Indians (51.5%), and lowest among Chinese (42.0%) consistent with higher prevalence of central obesity and higher percentage calorie intake from fat in the former groups of patients. On multivariate analysis, independent factors associated with NAFLD were central obesity (OR = 2.20, 95% CI = 1.29-3.75, P = 0.004) and elevated serum ALT level (OR = 1.98, 95% CI = 1.21-3.25, P = 0.007).
  
  
  CONCLUSIONS
  NAFLD was seen in half of a cohort of diabetic patients and was independently associated with central obesity and elevated serum ALT level. Prevalence of NAFLD was different and paralleled the difference in prevalence of central obesity and in percentage calorie intake from fat among the different ethnic groups.
authors.affiliation: Gastroenterology and Hepatology Unit, Gastrointestinal Endoscopy Unit, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia. wahkheong2003@hotmail.com
authors.forename: Wah-Kheong
authors.initials: WK
authors.lastname: Chan
authors.forename: Alexander Tong-Boon
authors.initials: AT
authors.lastname: Tan
authors.forename: Shireene Ratna
authors.initials: SR
authors.lastname: Vethakkan
authors.forename: Pei-Chien
authors.initials: PC
authors.lastname: Tah
authors.forename: Anushya
authors.initials: A
authors.lastname: Vijayananthan
authors.forename: Khean-Lee
authors.initials: KL
authors.lastname: Goh
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D002681:China / Q000208:ethnology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D004041:Dietary Fats; D002149:Energy Intake; D005234:Fatty Liver / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology* / Q000209:etiology; D005260:Female; D005544:Forecasting; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000208:ethnology; D008296:Malaysia / Q000453:epidemiology / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000453:epidemiology / Q000208:ethnology; D015995:Prevalence
chemical_list: D004041:Dietary Fats; D000410:Alanine Transaminase
keywords: diabetes mellitus; dietary intake; epidemiology; ethnicity; non-alcoholic fatty liver disease; physical activity