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Prevalence of Nonalcoholic Fatty Liver Disease and Its Association With Cardiovascular Disease Among Type 2 Diabetic Patients

¹ Department of Internal Medicine, "Sacro Cuore" Hospital, Negrar, Italy
² Section of Endocrinology, Department of Biomedical and Surgical Sciences, University Hospital of Verona, Verona, Italy
³ Department of Radiology, "Sacro Cuore" Hospital, Negrar, Italy
⁴ Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, U.K.

Address correspondence and reprint requests to Giovanni Targher, MD, Division of Internal Medicine and Diabetes Unit, Ospedale "Sacro Cuore–don Calabria," Via A. Sempreboni, 5, 37024 Negrar (VR), Italy. E-mail: targher{at}sacrocuore.it

OBJECTIVE—To determine the prevalence of nonalcoholic fatty liver disease (NAFLD) in type 2 diabetic population and to compare the prevalence of cardiovascular disease (CVD) and its risk factors between people with and without NAFLD.

RESEARCH DESIGN AND METHODS—The entire sample of type 2 diabetic outpatients (n = 2,839) who regularly attended our clinic was screened. Main outcome measures were NAFLD (by patient history and liver ultrasound) and manifest CVD (by patient history, review of patient records, electrocardiogram, and echo-Doppler scanning of carotid and lower limb arteries).

RESULTS—The unadjusted prevalence of NAFLD was 69.5% among participants, and NAFLD was the most common cause (81.5%) of hepatic steatosis on ultrasound examination. The prevalence of NAFLD increased with age (65.4% among participants aged 40–59 years and 74.6% among those aged 60 years; P < 0.001) and the age-adjusted prevalence of NAFLD was 71.1% in men and 68% in women. NAFLD patients had remarkably (P < 0.001) higher age and sex-adjusted prevalences of coronary (26.6 vs. 18.3%), cerebrovascular (20.0 vs. 13.3%), and peripheral (15.4 vs. 10.0%) vascular disease than their counterparts without NAFLD. In logistic regression analysis, NAFLD was associated with prevalent CVD independent of classical risk factors, glycemic control, medications, and metabolic syndrome features.

CONCLUSIONS—NAFLD is extremely common in people with type 2 diabetes and is associated with a higher prevalence of CVD. Follow-up studies are needed to determine whether NAFLD predicts the development and progression of CVD.

Abbreviations: ALT, alanine aminotransferase • ATP III, Adult Treatment Panel III • CVD, cardiovascular disease • NAFLD, nonalcoholic fatty liver disease • NASH, nonalcoholic steatohepatitis

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