Prevalence, trends and implications of association of nonalcoholic fatty liver disease in type 2 diabetes: Study from Western India (FATTYDIAB study).

Background and Aims: NAFLD is closely associated with type 2 diabetes, an integral component of metabolic syndrome. Materials and Methods: We conducted an initial phase of the long term, prospective, observational FATTYDIAB study in the Western Indian patients, evaluating the physical, biochemical and liver ultrasonography parameters for NAFLD in 200 T2DM confirmed patients, males (n = 144), females (n = 56); mean age 52.7 ± 9.1 years (range 32-80). Results: Stratified 3 age tertile pattern reflects increased prevalence of NAFLD (82%) in economically productive age group (<60 years). 71.5% (n = 143) had grade 1 (mild) to grade 2 (moderate) fatty liver. Bivariate correlation for NAFLD with changes in biochemical parameters were FPG; R = 0.064 (p = 0.368), PPG; R = 0.076 (p = 0.288), HbA1c; R = 0.145 (p = 0.040), SGOT; R = 0.181 (p = 0.010), SGPT; R = 0.162 (p = 0.022) and serum bilirubin; R = 0.069 (p = 0.331). Linear positive trends were evident for HbA1c with different grades of fatty liver (R2 = 0.021, F = 4.22; p = 0.040). Progression of HbA1c with NAFLD was Grade 0; 8.0 (7.6- 8.5), Grade 1; 8.6 (8.3-9.0), Grade 2; 8.7 (7.8-9.5) and Grade 3; 9.2 (7.5-11.0); Ptrend = 0.108. The physical and biochemical parameters revealed distinct patterns of dyslipidemia (low HDL and high triglycerides), blood pressure (mean systolic 133 mm hg) and BMI (mean 27). Conclusion: Epidemiological trends clearly demonstrate that the predominant patterns in the economically productive age group. The glycaemic markers (fasting, post prandial glucose and HbA1c) are strongly coorelated for prediction of NAFLD. However, the association of glycemic markers for progression of NAFLD was not statistically significant. An early aggressive intervention with a customised pharmacological approach to address the co-morbidities in these 'thin-fat' Indians is needed to improve clinical outcomes in type 2 diabetics with NAFLD. [ABSTRACT FROM AUTHOR]