title: High Prevalence of Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus and Normal Plasma Aminotransferase Levels.
abstract: NAFLD, and its more severe form with steatohepatitis (NASH), are common in patients with T2DM. However, they are usually believed to affect largely those with elevated aminotransferases. The aim of this study was to determine the prevalence of NAFLD (by the gold-standard liver magnetic resonance and spectroscopy or (1)H-MRS) in patients with T2DM and normal aminotransferases, and to characterize their metabolic profile.
  
  
  
  We recruited 103 patients with T2DM and normal plasma aminotransferases (age: 60±8 years, BMI: 33±5 kg/m(2), A1c: 7.6±1.3%). We measured: i) liver triglyceride content by (1)H-MRS; ii) systemic insulin sensitivity (HOMA-IR), and iii) adipose tissue insulin resistance (IR), both fasting (as the adipose tissue IR index: fasting plasma FFA x insulin) and during an OGTT (as the suppression of FFA).
  
  
  
  The prevalence of NAFLD and NASH were much higher than expected (76% and 56%, respectively). The prevalence of NAFLD was higher in obese compared to non-obese patients, as well as with increasing BMI (p=0.03 for trend). Higher plasma A1c was associated with a greater prevalence of NAFLD and worse liver triglyceride accumulation (p<0.01). Compared to non-obese patients without NAFLD, patients with NAFLD had severe systemic (liver/muscle), and particularly, adipose tissue (fasting/postprandial) insulin resistance (all p<0.01).
  
  
  
  The prevalence of NAFLD is much higher than previously believed in overweight/obese patients with T2DM and normal aminotransferases. Moreover, many are at increased risk of severe liver disease (NASH). Physicians should have a lower threshold for screening patients with T2DM for NAFLD/NASH.
authors.affiliation: 1Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL;|2Division of Endocrinology, Diabetes and Metabolism Malcom Randall Veterans Administration Medical Center (VAMC), Gainesville, FL;
authors.forename: Paola
authors.initials: P
authors.lastname: Portillo Sanchez
authors.affiliation: 1Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL;|2Division of Endocrinology, Diabetes and Metabolism Malcom Randall Veterans Administration Medical Center (VAMC), Gainesville, FL;
authors.forename: Fernando
authors.initials: F
authors.lastname: Bril
authors.affiliation: 1Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL;|2Division of Endocrinology, Diabetes and Metabolism Malcom Randall Veterans Administration Medical Center (VAMC), Gainesville, FL;
authors.forename: Maryann
authors.initials: M
authors.lastname: Maximos
authors.affiliation: 1Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL;
authors.forename: Romina
authors.initials: R
authors.lastname: Lomonaco
authors.affiliation: 2Division of Endocrinology, Diabetes and Metabolism Malcom Randall Veterans Administration Medical Center (VAMC), Gainesville, FL;
authors.forename: Diane
authors.initials: D
authors.lastname: Biernacki
authors.affiliation: 3Division of Diabetes, the University of Texas Health Science Center at San Antonio, and.|4Division of Diabetes and.
authors.forename: Beverly
authors.initials: B
authors.lastname: Orsak
authors.affiliation: 1Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL;|2Division of Endocrinology, Diabetes and Metabolism Malcom Randall Veterans Administration Medical Center (VAMC), Gainesville, FL;
authors.forename: Sreevidya
authors.initials: S
authors.lastname: Subbarayan
authors.affiliation: 5Division of Hepatology, Audie L. Murphy VAMC, San Antonio, TX.
authors.forename: Amy
authors.initials: A
authors.lastname: Webb
authors.affiliation: 3Division of Diabetes, the University of Texas Health Science Center at San Antonio, and.|4Division of Diabetes and.
authors.forename: Joan
authors.initials: J
authors.lastname: Hecht
authors.affiliation: 1Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL;|2Division of Endocrinology, Diabetes and Metabolism Malcom Randall Veterans Administration Medical Center (VAMC), Gainesville, FL;|3Division of Diabetes, the University of Texas Health Science Center at San Antonio, and.|4Division of Diabetes and.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Cusi
mesh_terms: D000273:Adipose Tissue / Q000503:physiopathology; D000368:Aged; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000201:enzymology / Q000453:epidemiology* / Q000503:physiopathology; D005215:Fasting; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005234:Fatty Liver / Q000453:epidemiology; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008099:Liver / Q000737:chemistry; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000201:enzymology / Q000453:epidemiology* / Q000503:physiopathology; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology*; D000637:Transaminases / Q000097:blood*; D014280:Triglycerides / Q000032:analysis
chemical_list: D005230:Fatty Acids, Nonesterified; D006442:Glycated Hemoglobin; D007328:Insulin; D000637:Transaminases; D014280:Triglycerides