NONALCOHOLIC FATTY LIVER DISEASE IN TYPE 2 DIABETES MELLITUS PATIENTS ATTENDING THE DIABETES CLINIC AT THE GREATER ACCRA REGIONAL HOSPITAL

Abstract

Background: Nonalcoholic fatty liver disease is currently the leading cause of chronic liver disease and the second leading indication for liver transplantation in developed countries. It may be complicated by cirrhosis and hepatocellular carcinoma. The pathogenesis of primary nonalcoholic fatty liver disease involves insulin resistance, which also occurs in type 2 diabetes mellitus. The prevalence of nonalcoholic fatty liver disease is increasing worldwide. However, published data on this condition in Ghana is scarce. General Objective: To determine the prevalence of, and factors associated with nonalcoholic fatty liver disease in type 2 diabetes mellitus patients attending the diabetes clinic at the Greater Accra Regional Hospital in Accra, Ghana. Methodology: This study was a cross-sectional, hospital-based study conducted at the Greater Accra Regional Hospital from May to October 2018. Two hundred and thirty-five type 2 diabetes mellitus patients with insignificant alcohol history and negative screens for hepatitis B and C infection were recruited using systematic random sampling, after giving informed consent. Socio- demographic and clinical data were obtained using a semi-structured questionnaire. Anthropometric measurements, general and abdominal examinations were performed for each participant. Laboratory investigations included full blood count, fasting blood sugar, glycated haemoglobin, lipids and liver biochemistry. Abdominal ultrasonography was performed to assess for liver size and echogenicity and to measure the abdominal subcutaneous fat thickness. Non- invasive scoring systems were used to predict the presence of nonalcoholic steatohepatitis and fibrosis. Captured data was imputed and analysed using SPSS 23.0. Results: The prevalence of nonalcoholic fatty liver disease among this cohort was 38.7% (91/235). Grade 3 disease was the most prevalent (46.1%). Prevalence of nonalcoholic steatohepatitis and fibrosis using non-invasive methods was estimated to be 23.1% and 26.4% respectively, in the population diagnosed with nonalcoholic fatty liver disease. Factors associated with presence of nonalcoholic fatty liver disease included age (p-value = 0.008), shorter duration of diabetes (p- value = 0.004), body mass index (p-value <0.0001), waist circumference (p-value = 0.006), waist/hip ratio (p-value = 0.001), abdominal subcutaneous fat thickness (p-value <0.0001), hepatomegaly (p-value <0.0001), glycated haemoglobin (p-value = 0.003) and hypertriglyceridaemia (p-value = 0.021). Increasing age (OR = 0.949; 95% CI: 0.918 - 0.980),

body mass index (OR = 1.108; 95% CI: 1.048- 1.171), hepatomegaly (OR = 4.230; 95% CI: 1.957 - 9.144) and elevated gamma-glutamyltransferase (OR = 3.591; 95% CI: 1.631 - 7.906) were found to be independent predictors of nonalcoholic fatty liver disease among this cohort. Conclusions: Roughly one-third of type 2 diabetes mellitus patients seen in clinics may have nonalcoholic fatty liver disease. Predictors of nonalcoholic fatty liver disease in this study include established non-modifiable risk factors such as age, as well as modifiable risk factors such as increased body mass index. Recommendations: Clinicians should utilize non-invasive markers to aid in the diagnosis of nonalcoholic fatty liver disease, especially in at-risk patients. Aggressive management of type 2 diabetes mellitus is needed to improve the outcome of the disease in Ghana. Further studies on the performance of non-invasive markers compared to liver biopsy are warranted in order to find alternate forms of diagnosis in low resource settings.