title: An association of large-fibre peripheral nerve dysfunction with non-invasive measures of liver fibrosis secondary to non-alcoholic fatty liver disease in diabetes.
abstract: OBJECTIVE
  To examine for an association of elevated lower-limb vibration perception threshold (VPT) with NAFLD fibrosis.
  
  
  METHODS
  Two cohorts from a tertiary diabetes centre were studied - Cohort 1, n=456 with type 1 or 2 diabetes, and Cohort 2, n=106 with type 2 diabetes mellitus. All underwent a detailed assessment, including VPT measurement. Cohort 2 also had liver ultrasound and transient elastography (TE). NAFLD Fibrosis Score (NFS) was calculated for all with available data. Follow-up VPT measurements on participants in Cohort 1 to 2014 were also collected if available.
  
  
  RESULTS
  Adjusted risk of higher VPT category (≥25V but <50V, or ≥50V, c.f. < 25V) was greater for high-risk NFS in both cohorts (Cohort 1, OR 2.22 [95% CI 1.24-3.98, p=0.007] and Cohort 2, OR 4.51 [95% CI 1.08-18.87], p=0.039) and higher liver stiffness measurement (LSM) by TE in Cohort 2 (OR for each unit natural log increase in LSM of 2.42 (95% CI 1.13-5.19), p=0.023). In Cohort 1, in those with VPT<50V and complete data, those with higher NFS had greater odds of increasing VPT category after 2.2 (IQR 1.5-2.9) years.
  
  
  CONCLUSIONS
  Higher VPT associates with markers of liver fibrosis due to NAFLD in diabetes mellitus.
authors: Central Clinical School, Room 408, Blackburn Building D06, The University of Sydney, New South Wales, Australia, 2006; Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, Australia, 2050; Charles Perkins Centre and Bosch Institute, Building D17, The University of Sydney, New South Wales, Australia, 2006. Electronic address: kath.williams@sydney.edu.au.
authors: Kathryn H
authors: KH
authors: Williams
authors: Central Clinical School, Room 408, Blackburn Building D06, The University of Sydney, New South Wales, Australia, 2006; Westmead Hospital, Cnr Darcy Road and Bridge Street, Westmead, NSW, Australia, 2145. Electronic address: kbur9770@uni.sydney.edu.au.
authors: Kharis
authors: K
authors: Burns
authors: Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, Australia, 2050. Electronic address: Maria.Constantino@sswahs.nsw.gov.au.
authors: Maria
authors: M
authors: Constantino
authors: Central Clinical School, Room 408, Blackburn Building D06, The University of Sydney, New South Wales, Australia, 2006; Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, Australia, 2050; Centenary Institute, Locked Bag 9, Newtown, New South Wales, Australia, 2042. Electronic address: n.shackel@centenary.usyd.edu.au.
authors: Nicholas A
authors: NA
authors: Shackel
authors: Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, Australia, 2050; Centenary Institute, Locked Bag 9, Newtown, New South Wales, Australia, 2042. Electronic address: e.prakoso@centenary.org.au.
authors: Emilia
authors: E
authors: Prakoso
authors: Central Clinical School, Room 408, Blackburn Building D06, The University of Sydney, New South Wales, Australia, 2006; Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, Australia, 2050. Electronic address: jencia.wong@sswahs.nsw.gov.au.
authors: Jencia
authors: J
authors: Wong
authors: Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, Australia, 2050. Electronic address: Ted.Wu@sswahs.nsw.gov.au.
authors: Ted
authors: T
authors: Wu
authors: Central Clinical School, Room 408, Blackburn Building D06, The University of Sydney, New South Wales, Australia, 2006; Westmead Hospital, Cnr Darcy Road and Bridge Street, Westmead, NSW, Australia, 2145; Westmead Millennium Institute for Clinical Research, P.O. Box 412, Westmead, New South Wales, Australia, 2145. Electronic address: jacob.george@sydney.edu.au.
authors: Jacob
authors: J
authors: George
authors: Central Clinical School, Room 408, Blackburn Building D06, The University of Sydney, New South Wales, Australia, 2006; Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, Australia, 2050; Centenary Institute, Locked Bag 9, Newtown, New South Wales, Australia, 2042. Electronic address: g.mccaughan@centenary.org.au.
authors: Geoffrey W
authors: GW
authors: McCaughan
authors: Central Clinical School, Room 408, Blackburn Building D06, The University of Sydney, New South Wales, Australia, 2006; Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, Australia, 2050; Charles Perkins Centre and Bosch Institute, Building D17, The University of Sydney, New South Wales, Australia, 2006. Electronic address: stephen.twigg@sydney.edu.au.
authors: Stephen M
authors: SM
authors: Twigg
mesh_terms: D000368:Aged; D015415:Biomarkers; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003929:Diabetic Neuropathies / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D054459:Elasticity Imaging Techniques; D005260:Female; D005500:Follow-Up Studies; D005528:Foot; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D010525:Peripheral Nerves / Q000503:physiopathology*; D012307:Risk Factors; D012684:Sensory Thresholds; D012720:Severity of Illness Index; D014732:Vibration
chemical_list: D015415:Biomarkers
keywords: Diabetes; Fibrosis; NAFLD; NAFLD fibrosis score; Peripheral neuropathy; Transient elastography