Clinical profile of non-alcoholic fatty liver disease and noninvasive analysis of NAFLD fibrosis score among type 2 diabetic patients in a tertiary care hospital.

Sathiamoorthy, S (2014) Clinical profile of non-alcoholic fatty liver disease and noninvasive analysis of NAFLD fibrosis score among type 2 diabetic patients in a tertiary care hospital. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION : NAFLD is considered as commonest liver problem of the western world where about 15-40% general population are affected. NAFLD stands as second and fourth cause for liver transplantation in large transplantation centres and in the United States, respectively. Approximately 20-30%and3-10%of Western adults and children are suffering from NAFLD and this value reaches up to 70-80% in the obese population. NAFLD has attained epidemic proportions even in countries at low risk, such as China (15%)and Japan (14%). This alarming increase in NAFLD is because NAFLD progresses from liver failure to cirrhosis to HCC. Many factors contribute to develop NAFLD including diabetes mellitus (T2DM) which can increase its risk and severity. Peripheral insulin resistance is a central mechanism for the pathogenesis of both entities. 10-75% of NAFLD patients have T2DM and 21-72% of diabetic patients are found to have NAFLD. The mortality rate in diabetic patients due to cirrhosis is above 2 times the general population and patients with NAFLD and DM have poorer prognosis in terms of higher rates of cirrhosis and mortality. NAFLD and T2DM are conditions highly dependent on genetic background and dietary factors. NAFLD is a spectrum with, simple steatosis (which remains stable over a period of years without progression in most patients) to steatohepatitis and advanced fibbrosis ( more risk for developing decompensated liver disease with portal hypertension to HCC, or death unless transplantation is done). Hence they need close follow-up and surveillance for esophageal varices and HCC and if required treatment. AIMS AND OBJECTIVES : 1. To study the prevalence of Non-alcoholic fatty liver disease based on ultrasound and study its clinical profile in type 2 diabetic patients attending outpatient clinic and inpatients in the Stanley medical college Hospital. 2. To apply the simple non invasive scoring system (NAFLD FIBROSIS SCORE) which helps in separating NAFLD patients with and without advanced liver fibrosis by using clinical and biochemical variables. 3. To correlate the NAFLD Fibrosis score (Indeterminate and high risk) in patients with high grade fatty liver (ultrasound) with the liver stiffness measured by transient elastography (FIBROSCAN) . CONCLUSIONS : The prevalence of non alcoholic liver disease among the diabetic population in this study was 63.8%higher compared to other series. Majority are females 83.1% in contrast to other series and the common age group was 56-65 years. The mean BMI was 28.04+4.12 kg/m2 and metabolic syndrome was present in 73%. Among the laboratory parameters used in the NAFLD fibrosis score raised AST more than ALT(Ratio >1),low serum albumin, low platelet count, high BMI were statistically significant. The non invasive NAFLD fibrosis score correlates significantly with the different grades of fatty liver detected by ultrasound and also with the liver stiffness measurement by transient elastography (Fibroscan). By comparing the intermediate and high NAFLD fibrosis score with fibroscan liver stiffness, 61% had either low or significant fibrosis and hence an invasive liver biopsy could be avoided in these set of patients to grade the degree of fibrosis. The combination of transient elastography (fibroscan) and NAFLD fibrosis scoring system may provide better performance than each of them used alone, in the non invasive analysis to select patients for whom to do a liver biopsy although this needs to be verified in future studies.

Item Type: Thesis (Masters)
Uncontrolled Keywords: non-alcoholic fatty liver disease ; noninvasive analysis ; NAFLD fibrosis score ; type 2 diabetic patients ; tertiary care hospital ; Clinical profile.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:20
Last Modified: 13 Jul 2017 04:20
URI: http://repository-tnmgrmu.ac.in/id/eprint/1589

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