Liver Stiffness Measurement is Useful in Predicting Type 2 Diabetes Mellitus Among Nonalcohol Fatty Liver Disease Patients

Figures & data

Figure 1 Flowchart of study population enrollment.

Table 1 Demographic Data of NAFLD Patients Without T2DM and NAFLD with T2DM Patients

Characteristics	All NAFLD Patients (n=154)	NAFLD Without T2DM (n=88)	NAFLD with T2DM (n=66)	P value
Age(y)	51.27±12.16	47.93±12.23	55.71±10.62	P=0.000
Male, N(%)	92(59.7)	58(65.9)	34(51.5)	P=0.071
BMI	27.22(20.98,36.75) (41)	27.43(23.89,36.05) (22)	26.85(20.98,36.75) (19)	P=0.433
MetS n(%)	71.0%(88/124)	62.5%(40/64)	80.0%(48/60)	P=0.032
Dyslipidemia(%)	65.3%(96/147)	67.9%(57/84)	61.9%(39/63)	P=0.453
Current smoking(%)	29.9%(35/117)	25.4%(16/63)	35.2%(19/54)	P=0.249
Drinking(%)	27.6%(32/116)	25.8%(16/62)	29.6%(16/54)	P=0.646
Hypertension(%)	38.5%(45/117)	27%(17/63)	51.9%(28/54)	P=0.006
SBP	127.53±14.95 (117)	124.37±14.49 (63)	131.22±14.71 (54)	P=0.013
DBP	81.03±9.147 (117)	81.59±9.52 (63)	80.39±8.74 (54)	P=0.482
CHD(%)	22.2%(26/117)	12.7%(8/63)	33.3%(18/54)	P=0.007
Cerebrovascular disease (%)	11.1%(13/117)	6.3%(4/63)	16.7%(9/54)	P=0.070

Abbreviations: T2DM, type 2 diabetes mellitus; MetS, Metabolic syndrome; SBP, Systolic blood pressures; DBP, Diastolic blood pressure; CHD, Coronary atherosclerotic heart disease; Drinking (defined < 30 g/day for men and< 20 g/day for women).

Table 2 Laboratory Variables of NAFLD Without and with T2DM in NAFLD Patients

Characteristics	All NAFLD Patients (n=154)	NAFLD without T2DM Patients (n=88)	NAFLD with T2DM Patients (n=66)	P value
Peripheral mononuclear cells	0.466±0.169	0.467±0.166	0.466±0.175	P=0.957
PLT count (1x10^9/L)	230.67±82.64	239.28±76.33	219.18±89.68	P=0.136
HBA1c(mmol/mol;%)	7.891±1.789 (44)	5.65±1.97 (6)	8.250±1.66 (38)	P=0.000
HOMA-IR	5.44(2,26) (35)	4.37(2,12) (18)	6.76 (2,26) (17)	P=0.019
AST(U/L)	32.62±21.88	30.09±18.68	36.00±25.30	P=0.097
ALT(U/L)	50.58±42.52	46.69±33.98	55.77±51.61	P=0.191
GGT(U/L)	43.0 (6,1385)	40.5 (11,711)	55 (6,1385)	P=0.017
TBil (mg/dL)	16.43±8.22	17.37±8.15	15.17±8.21	P=0.100
DBil (mg/dL)	5.11±3.05	5.01±2.45	5.24±3.72	P=0.636
SUA(mol/L)	357.44±99.49 (141)	382.69±98.84 (80)	324.32±90.94 (61)	P=0.004
Flns (U/L)	21.57±12.51 (42)	20.55±10.19 (22)	22.71±14.84 (20)	P=0.583
TC(mmol/L)	5.11±0.99 (140)	5.17±0.88 (80)	5.03±1.11 (60)	P=0.401
TG(mmol/L)	2.54±1.92 (140)	2.57±1.86 (80)	2.49±2.02 (60)	P=0.794
HDL(mmol/L)	1.10±0.56 (138)	1.14±0.70 (78)	1.04±0.30 (60)	P=0.301
LDL(mmol/L)	3.02±0.95 (138)	3.06±0.92 (78)	2.97±0.99 (60)	P=0.558
CAP	306.13±34.30	306.34±36.42	305.85±31.52	P=0.930
AST/ALT ratio	0.732(0.093, 2.73)	0.718 (0.096, 2.73)	0.748 (0.26, 2.32)	P=0.664
APRI	0.42(0.083, 6.932)	0.370 (0.089,6.93)	0.530 (0.083,2.658)	P=0.044
FIB-4	1.02(0.130,12.07)	0.905 (0.130,10.18)	1.330 (0.378,12.07)	P=0.001
LSM	7.71±7.34	5.73±2.58	10.37±10.26	P=0.000

Abbreviations: PLT, Platelet; HBA1c, hemoglobin A1c; HOMA-IR, homeostasis model of assessment for insulin resistance index; ALT, Alanine aminotransferase; AST, Aspartate Transaminase; TBL, total bilirubin; GGT, Gamma glutamyl transpeptidase; HDL, High-density lipoprotein cholesterol; TC, Total cholesterol; LDL, Low-density lipoprotein cholesterol; TG, Triglyceride; APRI, AST to platelet ratio index; FIB-4, Fibrosis-4 score; SUA, serum uric acid; CAP, Controlled attenuation parameter; LSM, Liver stiffness measurement; Flns, fasting insulin.

Table 3 Distribution of Patients According to the Stage of Liver Fibrosis

Stage of Fibrosis	No(%)
F0(0–5.9)	79(51.3)
F1(6–6.9)	22(14.3)
F2(7–9)	24(15.6)
F3(9.1–10.3)	6(3.9)
F4(≥10.4)	23(14.9)
Total	154(100)

Figure 2 Fibrosis level and the rate of type 2 diabetes in NAFLD patients.

Table 4 Multivariate Analysis of Factors Associated with Diabetes in NAFLD Patients

Variables	Univariate Analysis			Multivariate Analysis
	OR	95% CI	P value	OR	95% CI	P value
Age(ys)	1.061	(1.029 1.094)	0.000	1.018	(0.959 1.082)	0.554
Sex	0.550	(0.286 1.057)	0.073
ALT(U/L)	1.005	(0.997 1.013)	0.196
AST(U/L)	1.013	(0.997 1.029)	0.108
GGT(U/L)	1.005	(1.000 1.009)	0.045	1.002	(0.997 1.007)	0.510
TBiL(mg/dL)	0.965	(0.925 1.007)	0.105
SUA(mol/L)	0.993	(0.989 0.997)	0.001	0.995	(0.989 1.001)	0.095
TC(mmol/L)	0.862	(0.612 1.216)	0.398
TG(mmol/L)	0.977	(0.818 1.165)	0.792
HDL(mmol/L)	0.619	(0.227 1.689)	0.349
LDL(mmol/L)	0.898	(0.627 1.286)	0.556
APRI	1.188	(0.758 1.863)	0.452
FIB4	1.226	(0.982 1.531)	0.072
BMI	0.929	(0.786 1.099)	0.393
AST/ALT	1.302	(0.518 3.273)	0.574
CAP	1.000	(0.990 1.009)	0.930
LSM	1.271	(1.125 1.435)	0.000	1.466	(1.139 1.888)	0.003
Hypertension	2.914	(1.348 6.300)	0.007	0.567	(0.176 1.830)	0.343
CHD	3.437	(1.352 8.737)	0.009	0.459	(0.129 2.341)	0.418
MetS	2.400	(1.068 5.395)	0.034	0.273	(0.081 0.916)	0.036

Abbreviations: PLT, Platelet; HBA1c, hemoglobin A1c; HOMA-IR, homeostasis model of assessment for insulin resistance index; ALT Alanine aminotransferase; AST Aspartate Transaminase; TBL total bilirubin; GGT Gamma glutamyl transpeptidase; HDL High-density lipoprotein cholesterol; TC Total cholesterol; LDL Low-density lipoprotein cholesterol; TG, Triglyceride; APRI, AST to platelet ratio index; FIB-4, Fibrosis-4 score; SUA, serum uric acid; CAP, Controlled attenuation parameter; LSM, Liver stiffness measurement; CHD, coronary atherosclerotic heart disease; MetS, metabolic syndrome.