Non-alcoholic fatty liver disease in patients with type 2 diabetes in Greenland: a register-based cross-sectional study

Figures & data

Figure 1. Flowchart of in- and exclusion. T1DM: type 1 diabetes mellitus; T2DM: type 2 diabetes mellitus; EMR: electronic medical record; ALAT:alanine aminotransferase.

Table 1. Background characteristics of the cohort

Ethnicity/birthplace	Greenland (n=1409)	Denmark (n=182)	p-value
Age (years)	63 (IQR: 56–70)	64 (IQR: 59–71)	0.12
Sex, n (%) Male Female	650 (46.1%) 759 (53.9%)	165 (90.7%) 17 (9.3%)	<0.001
Anthropometrics, median (IQR) Height (cm) (n=1372/172) Weight (kg) (n=1383/174) BMI (kg/m^2) (n=1372/172) BMI groups, n (%) <18.5 kg/m^2 18.5–24.9 kg/m^2 25–29.9 kg/m^2 ≥30 kg/m^2	162 (IQR: 156–169) 84.0 (IQR: 71.5–98.1) 31.9 (IQR: 27.9–36.5) 7 (0.5%) 160 (11.6%) 338 (24.6%) 867 (63.2%)	178 (IQR: 172–183) 94.8 (IQR: 83.0–109) 30.5 (IQR: 26.9–33.9) 0 (0.0%) 28 (16.3%) 53 (30.8%) 91 (52.9%)	<0.001 <0.001 0.002 0.042
Biochemistry, median (IQR) HbA1c (mmol/mol) (n=1405/180) TC (mmol/l) (n=1355/177) LDL (mmol/l) (n=1352/177) HDL (mmol/l) (n=1356/177) TG (mmol/l) (n=1355/177) ALAT (U/L) (n=1409/182) ASAT (U/L) (n=1030/135) Platelets (10^9/l) (n=985/136)	52 (IQR: 47–61) 4.6 (IQR: 3.8–5.4) 2.1 (IQR: 1.5–2.9) 1.0 (IQR: 0.8–1.2) 2.0 (IQR: 1.4–3.0) 41 (IQR: 29–59) 27 (IQR: 22–35) 297 (IQR: 240–352)	56 (IQR: 48–67) 4.0 (IQR: 3.4–4.8) 1.8 (IQR: 1.3–2.8) 0.8 (IQR: 0.6–1.0) 1.8 (IQR: 1.3–2.9) 39 (IQR: 28–54) 23 (IQR: 19–29) 240 (IQR: 206–284)	0.002 <0.001 0.002 <0.001 0.247 0.157 <0.001 <0.001
Liver fibrosis, median (IQR) FIB-4 score (n=874/120) FIB-4 score categories, n (%) <1.45 1.45–2.67 >2.67 APRI score (n=874/120) APRI score categories, n (%) <0.7 0.7–1.0 >1.0	0.91 (IQR: 0.66–1.27) 737 (84.3%) 114 (13.0%) 23 (2.6%) 0.23 (IQR: 0.17–0.32) 849 (97.1%) 16 (1.8%) 9 (1.0%)	0.97 (IQR: 0.78–1.34) 96 (80.0%) 22 (18.3%) 2 (1.7%) 0.23 (IQR: 0.18–0.30) 117 (97.5%) 2 (1.7%) 1 (0.8%)	0.048 0.269 0.818 1.000
Hepatitis serology, n (%) P-HBsAg (n=320/25) P-anti-HCV (n=193/18)	Negative/positive test 309(96.6%)/11 (3.4%) 193 (100%)/0 (0.0%)	Negative/positive test 25 (100%)/0 (0.0%) 18 (100%)/0 (0.0%)	0.432
Blood pressure (mmHg)^a, median (IQR) Systolic (n=1389/173) Diastolic (n=1389/173)	134 (IQR: 125–143) 80 (IQR: 74–86)	134 (IQR: 125–141) 81 (IQR: 75–88)	0.908 0.219
Medication, n (%) Diabetes medications Anti-lipids Anti-hypertensives	973 (69.1%) 855 (60.7%) 1057 (75.0%)	149 (81.9%) 115 (63.2%) 147 (80.8%)	<0.001 0.514 0.089
Metabolic syndrome^b, n (%) 1 criterion met (T2DM alone) 2 criteria met 3 criteria met 4 criteria met 5 criteria met	37 (2.6%) 94 (6.7%) 184 (13.1%) 476 (33.8%) 618 (43.9%)	4 (2.2%) 6 (3.3%) 28 (15.4%) 75 (41.2%) 69 (37.9%)	0.107
Residence in Nuuk, n (%)	416 (29.5%)	111 (61.0%)	<0.001

In the EMR, T2DM was defined as the assignment of the T2DM diagnosis code according to the ICPC-2. p-values <0.05 were considered statistically significant.

^aBlood pressure measurements were predominantly performed at home. However, in some cases, only measurements from the doctor’s office were available.

^bAll included subjects had T2DM and fulfilled one criterion for the metabolic syndrome. Further criteria included were blood pressure ≥130/85 mmHg or antihypertensive treatment, plasma triglycerides ≥1.7 mmol/l or anti-lipidemic treatment, plasma HDL <1.0 mmol/l (men) and <1.3 mmol/l (women) or anti-lipidemic treatment and BMI >30 kg/m².

IQR: interquartile range; BMI: body mass index; ASAT: aspartate aminotransferase; ALAT: alanine aminotransferase; HbA1C: haemoglobin A1C; TC: total cholesterol; LDL: low-density lipoprotein; HDL: high-density lipoprotein; TG: triglycerides; HBsAg: hepatitis B surface antigen; HCV: hepatitis C virus; T2DM: type 2 diabetes mellitus; EMR: electronic medical records; ICPC-2: International Classification of Primary Care, 2nd edition.

Table 2. Univariable associations between ALAT and individual risk factors of the metabolic syndrome

Ethnicity/birthplace	Greenlanders		Danes
	rho	p	rho	p
HbA1c (mmol/mol)	0.06	0.024	−0.00	0.991
BMI (kg/m^2)	0.22	<0.001	0.23	0.003
Triglycerides (mmol/l)	0.12	<0.001	0.06	0.457
Total cholesterol (mmol/l)	0.08	0.004	0.06	0.414
LDL (mmol/l)	0.07	0.010	0.04	0.598
HDL (mmol/l)	−0.13	<0.001	−0.03	0.658
Systolic BP (mmHg)	−0.03	0.247	0.07	0.338
Diastolic BP (mmHg)	0.17	<0.001	0.06	0.404

The Spearman’s rank correlation was used to test the association between ALAT and metabolic syndrome variables. p-values <0.05 were considered statistically significant.

ALAT: alanine aminotransferase; rho: correlation coefficient; p: p-value; HbA1C: haemoglobin A1C; BMI: body mass index; LDL: low-density lipoprotein; HDL: high-density lipoprotein; and BP: blood pressure.

Table 3. Univariable associations between FIB-4 or APRI score and individual risk factors of the metabolic syndrome

	FIB-4 score				APRI score
Ethnicity/birthplace	Greenlanders		Danes		Greenlanders		Danes
	rho	p	rho	p	rho	p	rho	p
HbA1c (mmol/mol)	−0.19	<0.001	−0.15	0.101	−0.11	0.001	−0.16	0.081
BMI (kg/m^2)	−0.02	0.635	−0.03	0.756	0.14	<0.001	0.25	0.008
Triglycerides (mmol/l)	−0.17	<0.001	−0.02	0.843	−0.03	0.361	0.02	0.857
Total cholesterol (mmol/l)	−0.05	0.158	−0.11	0.243	0.01	0.724	−0.02	0.865
LDL (mmol/l)	−0.08	0.015	−0.09	0.312	0.01	0.712	−0.05	0.628
HDL (mmol/l)	0.10	0.002	−0.06	0.539	−0.00	0.887	−0.04	0.672
Systolic BP (mmHg)	0.17	<0.001	−0.02	0.798	0.03	0.354	0.03	0.727
Diastolic BP (mmHg)	−0.08	0.020	−0.09	0.315	0.08	0.021	0.06	0.525

The Spearman’s rank correlation was used to test the association between FIB-4 and APRI scores and metabolic syndrome variables. p-values <0.05 were considered statistically significant.

FIB-4: fibrosis-4; APRI: ASAT to Platelet Ratio Index; ASAT: aspartate aminotransferase; rho: correlation coefficient; p: p-value; HbA1C: haemoglobin A1C; BMI: body mass index; LDL: low-density lipoprotein; HDL: high-density lipoprotein; and BP: blood pressure.