A study on prevalence of non-alcoholic fatty liver disease in diabetes mellitus

ZAINAB, SUMAIN and YENKANCHI, ASHOK P and SHARIKH, MOHAMMED (2025) A study on prevalence of non-alcoholic fatty liver disease in diabetes mellitus. International Journal of Science and Research Archive, 15 (2). pp. 629-646. ISSN 2582-8185

NAFLD is commonly associated with Type 2 diabetes mellitus in clinical practice it is overlooked despite the significant clinical implications of NAFLD in Type 2 diabetes mellitus. Non-Alcoholic Fatty Liver Disease (NAFLD) in association with Type 2 Diabetes Mellitus (T2DM) can significantly increase the risk and severity of both conditions. Peripheral insulin resistance serves as a central mechanism in the pathogenesis of NAFLD and T2DM alike. The estimated prevalence of NAFLD in individuals with T2DM ranges from 70% to 75%. Patients diagnosed with both NAFLD and T2DM tend to have a poorer prognosis, with the mortality rate due to cirrhosis being notably higher in diabetic patients compared to the general population. This study was done to estimate the prevalence of NAFLD in diabetes mellitus. The term MASLD formally MAFLD will now be MASLD (Metabolic dysfunction - associated steatotic liver disease [51] MAFLD was defined as the presence of SLD with overweight/obesity (BMI > 25 kg/m2), T2DM or presence of metabolic dysregulation. MASLD was defined as SLD with atleast one cardiometabolic risk factor without excessive alcohol intake [51]. This new nomenclature defined by multisociety Delphi process and proposed by a panel of expert will help to differentiate people with pure MASLD from those MetALD (Metabolic liver disease associated with alcohol [51]. Methods: This cross-sectional observational study was conducted in both the outpatient and inpatient settings of the Department of General Medicine at Al-Ameen Medical College Hospital, Vijayapura, over a period of 18 month (July 2023 to December 2024). A total of 96 patients diagnosed with Type 2 Diabetes Mellitus (T2DM) or Type 1 DM on insulin therapy, who met the inclusion and exclusion criteria, were enrolled in the study. The inclusion criteria were based on the American Diabetes Association (ADA) guidelines¹⁸, which define diabetes as a fasting plasma glucose level of ≥126 mg/dL, a 2-hour postprandial blood glucose level of ≥200 mg/dL, or an HbA1C level of ≥6.5%. Patients were excluded if they had a history of alcohol consumption, tested positive for HIV, HCV, or HBsAg, or were on medications known to cause steatohepatitis, such as steroids, methotrexate, and estrogen-containing preparations. The sample size (n = 96) was obtained using Statulator software, based on an anticipated prevalence of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) among diabetic patients of 51.3%¹⁷, with a 95% confidence level and 10% absolute precision. Results: In our study of 96 diabetic patients, the majority (38.5%) were aged 21–40 years, with no significant age or gender differences (male-to-female ratio: 1.08:1). The overall prevalence of MASLD was 51.0%, with no statistically significant gender association. Obesity was significantly more common in MASLD patients (52.0%) than non-MASLD patients (19.7%) (P < 0.01), and BMI was significantly higher in the MASLD group. Central obesity markers, including waist circumference and waist-hip ratio, showed strong associations with MASLD in both males and females (P < 0.001). Additionally, liver enzymes (SGOT, SGPT, ALP) were significantly elevated in MASLD patients (40.8%) compared to non-MASLD patients (12.7%) (P < 0.01), highlighting their potential diagnostic value. Conclusion: MASLD is highly prevalent among diabetic patients, with obesity and dyslipidemia identified as major contributing factors, and liver function tests proving useful for early diagnosis. The study highlights the significance of metabolic parameters such as BMI, waist circumference, and lipid profile in the development of MASLD and supports existing evidence that MASLD independently contributes to liver dysfunction and metabolic complications in diabetics. Although no statistically significant gender difference in MASLD prevalence was observed, male patients demonstrated a higher tendency toward central obesity and associated metabolic changes. These findings underscore the importance of early screening and timely intervention to prevent the progression of MASLD in individuals with diabetes.