title: [Diabetes mellitus and nonalcoholic fatty liver disease: The verges of contingency].
abstract: OBJECTIVE
  To estimate the incidence of hepatic steatosis (HS) and liver fibrosis (LF) in patients with diabetes mellitus (DM), by applying the noninvasive techniques of liver fibroelastometry (LFE) and a battery of fibrotests (FTs); to determine their diagnostic value and to identify factors influencing the development of LF.
  
  
  METHODS
  A comprehensive examination was made in 82 diabetic patients (mean age, 56.7±12.7 years; p=0.033). The data were statistically evaluated using ROC curve analysis, correlation and single-factor analyses of variance, and multiple logistic regression analysis.
  
  
  RESULTS
  FTs and LFE revealed that the DM patients had liver cirrhosis (LC) (METAVIR F4) in 12 (14.6%) and 15 (18.2%) patients, respectively. Those showed clinically significant fibrosis (METAVIR fibrosis stages F2-3) in 19 (23.1%) and 23 (28%) patients, respectively. Varying degrees of HS were present in 79 (96.3%) patients. LFE and FTs demonstrated comparable results in detecting LC (the area under the receiver operating characteristics curve (AUROC), 0.83 and 0.81, respectively). The development of LF is influenced by factors, such as the degree of HS, obesity, the activity of an inflammatory process, and the level of alanine aminotransferase and α2-macroglobulin.
  
  
  CONCLUSIONS
  Diabetic patients are at high risk for NAFLD to develop LF and LC. LFE and FTs showed a comparably high accuracy in the diagnosis of LC in patients with DM and these may be used for screening. With allowance made for the existing risk factors of LF and LC, it is necessary to identify groups of patients with DM for further examination and follow-up. Patients who are diagnosed with stage F4 should be examined carefully to evaluate concurrent diseases and to make liver biopsy.
authors.affiliation: Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow, Russia.
authors.forename: I G
authors.initials: IG
authors.lastname: Bakulin
authors.affiliation: Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow, Russia.
authors.forename: Yu G
authors.initials: YG
authors.lastname: Sandler
authors.affiliation: Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow, Russia.
authors.forename: E V
authors.initials: EV
authors.lastname: Vinnitskaya
authors.affiliation: Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow, Russia.
authors.forename: V A
authors.initials: VA
authors.lastname: Keiyan
authors.affiliation: Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow, Russia.
authors.forename: S V
authors.initials: SV
authors.lastname: Rodionova
authors.affiliation: Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow, Russia.
authors.forename: D L
authors.initials: DL
authors.lastname: Rotin
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D048909:Diabetes Complications / Q000175:diagnosis* / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis* / Q000453:epidemiology