Alok Kulshrestha
Assistant Professor, Department of General Medicine, Venkateshwara Institute of Medical Sciences, Gajraula, Distt. Amroha (U.P.)- India
Vipin Kumar Gupta
Assistant Professor, Department of General Medicine, Venkateshwara Institute of Medical Sciences, Gajraula, Distt. Amroha (U.P.)- India
Abstract
BACKGROUND: The inspiration for this research was drawn from the highly frequent finding of ultrasonography reports which mentioned fatty infiltration of the liver with hepatomegaly‖ in T2D patients undergoing routine investigations. The reason for embarking on this research project was to find out the prevalence of NASH, which was considered the advanced form of fatty liver, and to evaluate the nature of the factors which increased the occurrence of NASH and its complications in people with T2D. The assessment was done with questionnaires, clinical examination, laboratory tests, and VCTE by trained and experienced medical personnel following standard protocols. Earlier studies on prevalence in India have relied on ultrasonography which was inadequate for the diagnosis of NASH.
AIM: The primary aim of the clinical study was to determine the prevalence of NASH in adults with T2D living in the region of India.
MATERIAL AND METHOD: This study was designed as a prospective, cross–sectional, observational study of adults with T2D living in a region of India. It was undertaken to provide an estimate of the current prevalence of NASH in the Indian region, which included areas around the city. This study will also determine the prevalence of factors that cause higher risks and their significance as predictors of NASH in patients with T2D. The cohort of subjects was derived by enrolling patients of T2D from three centers. All the patients with T2D attending these three medical clinics were offered enrolment in this study after they were explained the purpose by a nursing assistant. Medical and social history, lifestyle, smoking, alcohol drinking, physical activities, and clinical data were obtained using standard questionnaires. From the preliminary data collected, 500 subjects were enrolled in the study.
RESULTS: A cohort of 500 adults with T2D was evaluated and it was observed that NASH was present in 30% of the cohort studied. The prevalence in women was significantly higher than the prevalence seen in men. These percentages are low compared to a general population which does not specifically include subjects with T2D because the majority of adults with T2D are overweight or obese, and lean NAFLD is far less common in this group compared to a general population. This study has found that though there is a significant association of liver transaminases with liver fibrosis, these tests lack adequate sensitivity and specificity to be considered important biomarkers for NASH in T2D.
CONCLUSION: The findings in this study strongly suggest that there is a need to develop strategies to increase awareness among physicians and increase their motivation to implement multifactorial interventions to prevent the progress of NAFLD to advanced stages of NASH and severe fibrosis, which may lead to the development of CVD complications, cirrhosis, and hepatocellular carcinoma. The burden of complications due to NASH in patients with T2D is huge because of the sheer number of patients and this will prove to be a major strain on public health resources.
KEYWORDS: Acute Myocardial Infarction, Alcoholic Liver Disease, Alanine Aminotransferase, Arterial Stiffness, Adipose Tissue Dysfunction.