title: Nonalcoholic fatty liver disease is associated with an increased prevalence of distal symmetric polyneuropathy in adult patients with type 1 diabetes.
abstract: OBJECTIVE
  Presently, data on the association between nonalcoholic fatty liver disease (NAFLD) and distal symmetric polyneuropathy in people with diabetes are scarce and conflicting. The aim of this retrospective, cross-sectional study was to examine whether NAFLD was associated with an increased prevalence of distal symmetric polyneuropathy in type 1 diabetic adults.
  
  
  METHODS
  We studied all white type 1 diabetic outpatients (n = 286, 42.3% male, mean age 43 ± 14 years, median diabetes duration 17 [10-30] years), who participated in a foot screening program at our adult diabetes clinic after excluding those who had excessive alcohol consumption and other known causes of chronic liver disease. NAFLD was diagnosed by ultrasonography. Distal symmetric polyneuropathy was detected using the Michigan Neuropathy Screening Instrument method and the biothesiometer Vibrotest.
  
  
  RESULTS
  Overall, the prevalence rates of NAFLD and distal symmetric polyneuropathy were 52.4% and 35.3%, respectively. Patients with NAFLD had a substantially increased prevalence of distal symmetric polyneuropathy compared to their counterparts without NAFLD (51.0% vs. 17.1%, p < 0.001). In univariate analysis, NAFLD was associated with an approximately 5-fold increased risk of prevalent distal symmetric polyneuropathy (odds ratio [OR] 5.32, 95% confidence interval [CI] 3.1-9.3, p < 0.001). This association remained significant even after adjustment for age, sex, diabetes duration, hemoglobin A1c, diabetic retinopathy, smoking, metabolic syndrome, chronic kidney disease and carotid artery stenoses ≥ 40% (adjusted-OR 2.23, 95% CI 1.1-4.8, p < 0.05).
  
  
  CONCLUSIONS
  Our results show that NAFLD, diagnosed by ultrasonography, is strongly associated with an increased risk of distal symmetric polyneuropathy in type 1 diabetic adults, independently of several cardio-metabolic risk factors.
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy. Electronic address: alessandro.mantovani24@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mantovani
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Rigolon
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Mingolla
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Pichiri
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Cavalieri
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Salvotelli
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Stoico
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zoppini
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Bonora
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Targher
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000453:epidemiology*; D003929:Diabetic Neuropathies / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000453:epidemiology*; D011115:Polyneuropathies / Q000150:complications / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies
keywords: Distal symmetric polyneuropathy; Microvascular complication; Nonalcoholic fatty liver disease; Peripheral diabetic neuropathy; Type 1 diabetes