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Erschienen in: Diabetologia 3/2008

01.03.2008 | Article

Non-alcoholic fatty liver disease is independently associated with an increased prevalence of chronic kidney disease and proliferative/laser-treated retinopathy in type 2 diabetic patients

verfasst von: G. Targher, L. Bertolini, S. Rodella, G. Zoppini, G. Lippi, C. Day, M. Muggeo

Erschienen in: Diabetologia | Ausgabe 3/2008

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Abstract

Aims/hypothesis

Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiovascular disease in type 2 diabetes. Currently, there is a lack of information on associations between NAFLD and microvascular complications of diabetes. We assessed the associations between NAFLD and both chronic kidney disease (CKD) and retinopathy in a large cohort of type 2 diabetic individuals using a cross-sectional design.

Methods

Prevalence rates of retinopathy (by ophthalmoscopy) and CKD (defined as overt proteinuria and/or estimated GFR ≤60 ml min−1 1.73 m−2) were assessed in 2,103 type 2 diabetic individuals who were free of diagnosed cardiovascular disease and viral hepatitis. NAFLD was ascertained by patient history, blood sampling and liver ultrasound.

Results

NAFLD patients had higher (p < 0.001) age- and sex-adjusted prevalence rates of both non-proliferative (39 vs 34%) and proliferative/laser-treated retinopathy (11 vs 5%), and CKD (15 vs 9%) than counterparts without NAFLD. In logistic regression analysis, NAFLD was associated with increased rates of CKD (odds ratio 1.87; 95% CI 1.3–4.1, p = 0.020) and proliferative/laser-treated retinopathy (odds ratio 1.75; 1.1–3.7, p = 0.031) independently of age, sex, BMI, waist circumference, hypertension, diabetes duration, HbA1c, lipids, smoking status and medications use.

Conclusions/interpretation

Our findings suggest that NAFLD is associated with an increased prevalence of CKD and proliferative/laser-treated retinopathy in type 2 diabetic individuals independently of numerous baseline confounding factors. Further studies are required to confirm the reproducibility of these results and to evaluate whether NAFLD contributes to the development or progression of CKD and retinopathy.
Literatur
1.
Zurück zum Zitat Adams LA, Angulo P, Lindor KD (2005) Nonalcoholic fatty liver disease. CMAJ 172:899–905PubMed Adams LA, Angulo P, Lindor KD (2005) Nonalcoholic fatty liver disease. CMAJ 172:899–905PubMed
2.
Zurück zum Zitat Day CP (2006) Nonalcoholic fatty liver disease: current concepts and management strategies. Clin Med 6:19–25PubMed Day CP (2006) Nonalcoholic fatty liver disease: current concepts and management strategies. Clin Med 6:19–25PubMed
3.
Zurück zum Zitat McCullough AJ (2006) Pathophysiology of non-alcoholic steatohepatitis. J Clin Gastroenterol 40 (Suppl 1):S17–S29PubMed McCullough AJ (2006) Pathophysiology of non-alcoholic steatohepatitis. J Clin Gastroenterol 40 (Suppl 1):S17–S29PubMed
4.
Zurück zum Zitat Marchesini G, Marzocchi R, Agostini F, Bugianesi E (2005) Nonalcoholic fatty liver disease and the metabolic syndrome. Curr Opin Lipidol 16:421–427PubMedCrossRef Marchesini G, Marzocchi R, Agostini F, Bugianesi E (2005) Nonalcoholic fatty liver disease and the metabolic syndrome. Curr Opin Lipidol 16:421–427PubMedCrossRef
5.
Zurück zum Zitat Clark JM, Brancati FL, Diehl AM (2003) The prevalence and aetiology of elevated aminotransferase levels in the United States. Am J Gastroenterol 98:960–967PubMedCrossRef Clark JM, Brancati FL, Diehl AM (2003) The prevalence and aetiology of elevated aminotransferase levels in the United States. Am J Gastroenterol 98:960–967PubMedCrossRef
6.
Zurück zum Zitat Bedogni G, Miglioli L, Masutti F, Tiribelli C, Marchesini G, Bellentani S (2005) Prevalence of and risk factors for non-alcoholic fatty liver disease: the Dionysos Nutrition and Liver Study. Hepatology 42:44–52PubMedCrossRef Bedogni G, Miglioli L, Masutti F, Tiribelli C, Marchesini G, Bellentani S (2005) Prevalence of and risk factors for non-alcoholic fatty liver disease: the Dionysos Nutrition and Liver Study. Hepatology 42:44–52PubMedCrossRef
7.
Zurück zum Zitat Browning JD, Szczepaniak LS, Dobbins R et al (2004) Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 40:1387–1395PubMedCrossRef Browning JD, Szczepaniak LS, Dobbins R et al (2004) Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 40:1387–1395PubMedCrossRef
8.
Zurück zum Zitat Medina J, Fernandez-Salazar LI, Garcia-Buey L, Moreno-Otero R (2004) Approach to the pathogenesis and treatment of non-alcoholic steatohepatitis. Diabetes Care 27:2057–2066PubMedCrossRef Medina J, Fernandez-Salazar LI, Garcia-Buey L, Moreno-Otero R (2004) Approach to the pathogenesis and treatment of non-alcoholic steatohepatitis. Diabetes Care 27:2057–2066PubMedCrossRef
9.
Zurück zum Zitat Targher G, Bertolini L, Padovani R et al. (2007) Prevalence of non-alcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients. Diabetes Care 30:1212–1218PubMedCrossRef Targher G, Bertolini L, Padovani R et al. (2007) Prevalence of non-alcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients. Diabetes Care 30:1212–1218PubMedCrossRef
10.
Zurück zum Zitat Targher G, Bertolini L, Padovani R et al (2006) Increased prevalence of cardiovascular disease among type 2 diabetic patients with non-alcoholic fatty liver disease. Diabet Med 23:403–409PubMedCrossRef Targher G, Bertolini L, Padovani R et al (2006) Increased prevalence of cardiovascular disease among type 2 diabetic patients with non-alcoholic fatty liver disease. Diabet Med 23:403–409PubMedCrossRef
11.
Zurück zum Zitat Targher G, Bertolini L, Poli F et al (2005) Nonalcoholic fatty liver disease and risk of future cardiovascular events among type 2 diabetic patients. Diabetes 54:3541–3546PubMedCrossRef Targher G, Bertolini L, Poli F et al (2005) Nonalcoholic fatty liver disease and risk of future cardiovascular events among type 2 diabetic patients. Diabetes 54:3541–3546PubMedCrossRef
12.
Zurück zum Zitat Targher G, Bertolini L, Rodella S et al (2007) Nonalcoholic fatty liver disease is independently associated with an increased incidence of cardiovascular events in type 2 diabetic patients. Diabetes Care 30:2119–2121PubMedCrossRef Targher G, Bertolini L, Rodella S et al (2007) Nonalcoholic fatty liver disease is independently associated with an increased incidence of cardiovascular events in type 2 diabetic patients. Diabetes Care 30:2119–2121PubMedCrossRef
13.
Zurück zum Zitat Targher G, Arcaro G (2007) Nonalcoholic fatty liver disease and increased risk of cardiovascular disease. Atherosclerosis 191:235–240PubMedCrossRef Targher G, Arcaro G (2007) Nonalcoholic fatty liver disease and increased risk of cardiovascular disease. Atherosclerosis 191:235–240PubMedCrossRef
14.
Zurück zum Zitat Levey AS, Coresh J, Balk E et al; National Kidney Foundation (2003) National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 139:137–147PubMed Levey AS, Coresh J, Balk E et al; National Kidney Foundation (2003) National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 139:137–147PubMed
15.
Zurück zum Zitat American Diabetes Association (2007) Standards of medical care in diabetes—2007. Diabetes Care 30 (Suppl 1):S4–S41CrossRef American Diabetes Association (2007) Standards of medical care in diabetes—2007. Diabetes Care 30 (Suppl 1):S4–S41CrossRef
16.
Zurück zum Zitat Wilkinson CP, Ferris FL, Klein RE et al; Global Diabetic Retinopathy Project Group (2003) Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 110:1677–1682PubMedCrossRef Wilkinson CP, Ferris FL, Klein RE et al; Global Diabetic Retinopathy Project Group (2003) Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 110:1677–1682PubMedCrossRef
17.
Zurück zum Zitat Targher G, Bertolini L, Zoppini G, Lippi G, Zenari L (2007) Diabetic retinopathy predicts cardiovascular mortality in type 2 diabetic men and women: response to Juutilainen et al. [Letter]. Diabetes Care 30:e51PubMedCrossRef Targher G, Bertolini L, Zoppini G, Lippi G, Zenari L (2007) Diabetic retinopathy predicts cardiovascular mortality in type 2 diabetic men and women: response to Juutilainen et al. [Letter]. Diabetes Care 30:e51PubMedCrossRef
18.
Zurück zum Zitat Saadeh S, Younossi ZM, Remer EM et al (2002) The utility of radiological imaging in non-alcoholic fatty liver disease. Gastroenterology 123:745–750PubMedCrossRef Saadeh S, Younossi ZM, Remer EM et al (2002) The utility of radiological imaging in non-alcoholic fatty liver disease. Gastroenterology 123:745–750PubMedCrossRef
19.
Zurück zum Zitat Targher G, Bertolini L, Padovani R, Zenari L, Zoppini G, Falezza G (2004) Relation of non-alcoholic hepatic steatosis to early carotid atherosclerosis in healthy men. Role of visceral fat accumulation. Diabetes Care 27:1498–1500 Targher G, Bertolini L, Padovani R, Zenari L, Zoppini G, Falezza G (2004) Relation of non-alcoholic hepatic steatosis to early carotid atherosclerosis in healthy men. Role of visceral fat accumulation. Diabetes Care 27:1498–1500
20.
Zurück zum Zitat Ryu S, Chang Y, Kim DI, Kim WS, Suh BS (2007) Gamma-glutamyltransferase as a predictor of chronic kidney disease in nonhypertensive and nondiabetic Korean men. Clin Chem 53:71–77PubMedCrossRef Ryu S, Chang Y, Kim DI, Kim WS, Suh BS (2007) Gamma-glutamyltransferase as a predictor of chronic kidney disease in nonhypertensive and nondiabetic Korean men. Clin Chem 53:71–77PubMedCrossRef
21.
Zurück zum Zitat Ratziu V, Imbert-Bismut F, Messous D, Poynard T (2004) The elusiveness of “normal” ALT in fatty liver. Hepatology 39:1172PubMedCrossRef Ratziu V, Imbert-Bismut F, Messous D, Poynard T (2004) The elusiveness of “normal” ALT in fatty liver. Hepatology 39:1172PubMedCrossRef
22.
Zurück zum Zitat Belfort R, Harrison SA, Brown K et al (2006) A placebo-controlled trial of pioglitazone in subjects with non-alcoholic steatohepatitis. N Engl J Med 355:2297–2307PubMedCrossRef Belfort R, Harrison SA, Brown K et al (2006) A placebo-controlled trial of pioglitazone in subjects with non-alcoholic steatohepatitis. N Engl J Med 355:2297–2307PubMedCrossRef
23.
Zurück zum Zitat Alessi MC, Bastelica D, Mavri A et al (2003) Plasma PAI-1 levels are more strongly related to liver steatosis than to adipose tissue accumulation. Arterioscler Thromb Vasc Biol 23:1262–1268PubMedCrossRef Alessi MC, Bastelica D, Mavri A et al (2003) Plasma PAI-1 levels are more strongly related to liver steatosis than to adipose tissue accumulation. Arterioscler Thromb Vasc Biol 23:1262–1268PubMedCrossRef
24.
Zurück zum Zitat Targher G, Bertolini L, Scala L et al (2007) Plasma PAI-1 levels are increased in patients with non-alcoholic steatohepatitis. Diabetes Care 30:e31–e32PubMedCrossRef Targher G, Bertolini L, Scala L et al (2007) Plasma PAI-1 levels are increased in patients with non-alcoholic steatohepatitis. Diabetes Care 30:e31–e32PubMedCrossRef
25.
Zurück zum Zitat Targher G (2006) Relationship between high-sensitivity C-reactive protein levels and liver histology in subjects with non-alcoholic fatty liver disease. J Hepatol 45:879–881PubMedCrossRef Targher G (2006) Relationship between high-sensitivity C-reactive protein levels and liver histology in subjects with non-alcoholic fatty liver disease. J Hepatol 45:879–881PubMedCrossRef
26.
Zurück zum Zitat Targher G, Bertolini L, Padovani R, Rodella S, Arcaro G, Day C (2007) Differences and similarities in early atherosclerosis between patients with non-alcoholic steatohepatitis and chronic hepatitis B and C. J Hepatol 46:1126–1132PubMedCrossRef Targher G, Bertolini L, Padovani R, Rodella S, Arcaro G, Day C (2007) Differences and similarities in early atherosclerosis between patients with non-alcoholic steatohepatitis and chronic hepatitis B and C. J Hepatol 46:1126–1132PubMedCrossRef
27.
28.
Zurück zum Zitat Horiuchi S (2002) The liver is the main site for metabolism of circulating advanced glycation end products. J Hepatol 36:123–125PubMedCrossRef Horiuchi S (2002) The liver is the main site for metabolism of circulating advanced glycation end products. J Hepatol 36:123–125PubMedCrossRef
29.
Zurück zum Zitat Abiru S, Migita K, Maeda Y et al (2006) Serum cytokine and soluble cytokine receptor levels in patients with non-alcoholic steatohepatitis. Liver Int 26:39–45PubMedCrossRef Abiru S, Migita K, Maeda Y et al (2006) Serum cytokine and soluble cytokine receptor levels in patients with non-alcoholic steatohepatitis. Liver Int 26:39–45PubMedCrossRef
30.
Zurück zum Zitat Holt HB, Wild SH, Wood PJ et al (2006) Non-esterified fatty acid concentrations are independently associated with hepatic steatosis in obese subjects. Diabetologia 49:141–148PubMedCrossRef Holt HB, Wild SH, Wood PJ et al (2006) Non-esterified fatty acid concentrations are independently associated with hepatic steatosis in obese subjects. Diabetologia 49:141–148PubMedCrossRef
31.
Zurück zum Zitat Chalasani N, Deeg MA, Crabb DW (2004) Systemic levels of lipid peroxidation and its metabolic and dietary correlates in patients with non-alcoholic steatohepatitis. Am J Gastroenterol 99:1497–1502PubMedCrossRef Chalasani N, Deeg MA, Crabb DW (2004) Systemic levels of lipid peroxidation and its metabolic and dietary correlates in patients with non-alcoholic steatohepatitis. Am J Gastroenterol 99:1497–1502PubMedCrossRef
32.
Zurück zum Zitat Albano E, Mottaran E, Vidali M et al (2005) Immune response towards lipid peroxidation products as a predictor of progression of non-alcoholic fatty liver disease to advanced fibrosis. Gut 54:987–993PubMedCrossRef Albano E, Mottaran E, Vidali M et al (2005) Immune response towards lipid peroxidation products as a predictor of progression of non-alcoholic fatty liver disease to advanced fibrosis. Gut 54:987–993PubMedCrossRef
33.
Zurück zum Zitat Chen AYS, Kong APS, Wong VWS et al (2006) Chronic hepatitis B viral infection independently predicts renal outcome in type 2 diabetic patients. Diabetologia 49:1777–1784CrossRef Chen AYS, Kong APS, Wong VWS et al (2006) Chronic hepatitis B viral infection independently predicts renal outcome in type 2 diabetic patients. Diabetologia 49:1777–1784CrossRef
34.
Zurück zum Zitat Groop PH, Forsblom C, Thomas MC (2005) Mechanisms of disease: pathway-selective insulin resistance and microvascular complications of diabetes. Nat Clin Pract Endocrinol Metab 1:100–110PubMedCrossRef Groop PH, Forsblom C, Thomas MC (2005) Mechanisms of disease: pathway-selective insulin resistance and microvascular complications of diabetes. Nat Clin Pract Endocrinol Metab 1:100–110PubMedCrossRef
35.
Zurück zum Zitat Sarafidis PA, Ruilope LM (2006) Insulin resistance, hyperinsulinemia, and renal injury: mechanisms and implications. Am J Nephrol 26:232–244PubMedCrossRef Sarafidis PA, Ruilope LM (2006) Insulin resistance, hyperinsulinemia, and renal injury: mechanisms and implications. Am J Nephrol 26:232–244PubMedCrossRef
36.
Zurück zum Zitat Marshall SM, Flyvbjerg A (2006) Prevention and early detection of vascular complications of diabetes. BMJ 333:475–480PubMedCrossRef Marshall SM, Flyvbjerg A (2006) Prevention and early detection of vascular complications of diabetes. BMJ 333:475–480PubMedCrossRef
Metadaten
Titel
Non-alcoholic fatty liver disease is independently associated with an increased prevalence of chronic kidney disease and proliferative/laser-treated retinopathy in type 2 diabetic patients
verfasst von
G. Targher
L. Bertolini
S. Rodella
G. Zoppini
G. Lippi
C. Day
M. Muggeo
Publikationsdatum
01.03.2008
Verlag
Springer-Verlag
Erschienen in
Diabetologia / Ausgabe 3/2008
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-007-0897-4

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