Evaluating Risk Factors for Development of Non-Alcoholic Steatohepatitis in Type-II Diabetes Mellitus

Background and Aims: Non-alcoholic steatohepatitis (NASH) is reported to be present in 49-86% of patients with type- II diabetes mellitus (DM). Risk factors for the development of NASH in DM are not clear. This prospective analysis was planned to define the chronological relation between DM and NASH as well as to define risk factors for the development of NASH in DM. Methods: In a 3-year study, all consecutive NASH patients (n=100, age= 42.8±4.6 years, M: F=4.2:1) were evaluated for the presence of DM, at baseline and during three monthly follow-up. In NASH patient with DM (group A, n=27, age=39.3±5.2 years, M: F=4.4:1), risk factors such as obesity, central obesity, dyslipidemia and family history of chronic liver disease were evaluated for comparative analysis. Similar number of consecutive patients of DM without evidence of liver disease (group B, n=27, age=45.9±5.6 years, M: F=3:1) were analyzed for similar parameters. Results: Among 100 patients with NASH, 27 (27%) patients had DM of whom, DM was preexisting in 13 (48.1%), was diagnosed at baseline in 11 (40.7%) and was diagnosed during follow-up in 3 (11.1%) patient. On statistical analysis (group A vs. group B), none of the risk factors were found to be statically significant: obesity (77.7% vs. 70.3%), central obesity (88.8% vs. 92.5%), dyslipidemia (51.8% vs. 44.4%), hypolipoproteinemia (7.4% vs. 3.7%), family history of chronic liver disease (7.4% vs. 0%), family history of DM (62.9% vs. 66.6%), hypertension (18.5% vs. 14.8%), ischemic heart disease (7.4% vs. 11.1%), cerebrovascular disease (3.7% vs. 0%) and hyperuricemia (11.1% vs. 14.8%). Conclusions: DM does not always precede NASH, but may follow NASH in some patients. Risk factors like obesity, central obesity, dyslipidemia and family history do not predict the development of NASH in diabetic patients.