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Ann Hepatol. 2018 July - August ,;17(4):585-591. doi: 10.5604/01.3001.0012.0922.

Impact of Diabetes Mellitus and Insulin on Nonalcoholic Fatty Liver Disease in the Morbidly Obese.

Author information

1
Department of Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
2
Obesity Treatment Center, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
3
Department of Internal Medicine, Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul, Proto Alegre, RS, Brazil.

Abstract

INTRODUCTION AND AIM:

The prevalence of obesity, type 2 diabetes mellitus and non-alcoholic fatty liver disease are increasing. Type 2 diabetes mellitus may aggravate non-alcoholic fatty liver disease, increasing the risk of developing cirrhosis and hepatocellular carcinoma. This study aims to determine the effect of type 2 diabetes mellitus and insulin therapy on non-alcoholic fatty liver disease in the patients with morbid obesity.

MATERIAL AND METHODS:

Clinical, anthropometric and laboratory data were analyzed together with intraoperative liver biopsies from morbidly obese patients undergoing bariatric surgery.

RESULTS:

219 patients with morbid obesity were evaluated. Systemic arterial hypertension (55.9% vs. 33.8%, p = 0.004) and dyslipidemia (67.1% vs. 39.0%, p < 0.001) were more prevalent in patients with diabetes when compared to patients without diabetes. In multivariate analysis, type 2 diabetes mellitus was an independent risk factor for severe steatosis (RR = 2.04, p = 0.023) and severe fibrosis (RR = 4.57, p = 0.013). Insulin therapy was significantly associated with non-alcoholic steatohepatitis (RR = 1.89, p = 0.001) and fibrosis (RR = 1.75, p = 0.050) when all patients were analysed, but when only patients with diabetes were analysed, insulin therapy was not associated with non-alcoholic steatohepatitis or fibrosis.

CONCLUSION:

Type 2 diabetes mellitus plays an important role in the progression of non-alcoholic fatty liver disease as an independent risk factor for severe fibrosis.

KEYWORDS:

Bariatric surgery; NASH; Obese patients; Steatosis

PMID:
29893699
DOI:
10.5604/01.3001.0012.0922
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