The Burden of NAFLD and Its Characteristics in a Nationwide Population with Type 2 Diabetes.
OBJECTIVE
We studied the prevalence of nonalcoholic fatty liver disease (NAFLD) and its clinical correlates in a population of patients with type 2 diabetes mellitus (T2DM).


METHODS
Clinical data of 94,577 T2DM patients were retrieved from 160 diabetes clinics in Italy in a standardized format and centrally analyzed anonymously. After exclusion of 5967 cases (high or uncertain alcohol intake), in 38,880 the Fatty Liver Index (FLI) was used as a proxy for the diagnosis of NAFLD. Factors associated with FLI assessed NAFLD (FLI-NAFLD) were evaluated through multivariate analysis.


RESULTS
FLI-NAFLD was present in 59.6% of patients. Compared to non-NAFLD, FLI-NAFLD was associated with impairment in renal function, higher albumin excretion, HbA1c and blood pressure, lower HDL cholesterol, and poorer quality of care. ALT was within normal limits in 73.6% of FLI-NAFLD patients (45.6% if the updated reference values were used). The prevalence of FLI-NAFLD did not differ if the whole sample (94,577 cases) was examined, irrespective of alcohol intake.


CONCLUSIONS
FLI-NAFLD was present in the majority of T2DM patients of our sample and metabolic derangement, not alcohol consumption, was mainly associated with the disease. FLI-NAFLD patients have a worse metabolic profile. ALT levels are not predictive of NAFLD.
Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University of Bologna, 40138 Bologna, Italy.
Gabriele
G
Forlani
Diabetes and Metabolism Unit, ASL Turin 5, 10023 Chieri, Italy.
Carlo
C
Giorda
Diabetes and Metabolism Unit, ASL Turin 5, 10023 Chieri, Italy.
Roberta
R
Manti
Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University of Bologna, 40138 Bologna, Italy.
Natalia
N
Mazzella
Unit of Internal Medicine, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy.
Salvatore
S
De Cosmo
Center for Outcomes Research and Clinical Epidemiology (CORE), 65124 Pescara, Italy.
Maria Chiara
MC
Rossi
Center for Outcomes Research and Clinical Epidemiology (CORE), 65124 Pescara, Italy.
Antonio
A
Nicolucci
Diabetes Unit, AUSL Romagna, 48121 Ravenna, Italy.
Paolo
P
Di Bartolo
Biomedical Research Institute August Pi Sunyer (IDIBAPS) and Center for Biomedical Research in Diabetes and Associated Metabolic Disorders (CIBERDEM), 08036 Barcelona, Spain.
Antonio
A
Ceriello
AMD (Italian Association of Clinical Diabetologists), 00192 Rome, Italy.
Pietro
P
Guida
AMD (Italian Association of Clinical Diabetologists), 00192 Rome, Italy.
D000368:Aged; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006306:Health Surveys; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors
D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human