Professor Patricia Valery

Greater vigilance is needed for early detection and monitoring of liver complications in patients with non-alcoholic fatty liver disease and diabetes, a Queensland study shows.

Researchers at the QIMR Berghofer Medical Research Institute, Brisbane, showed that more than one‐third of people with NAFLD‐related cirrhosis and diabetes mellitus experience cirrhosis complications within ten years.

And since one in five people with diabetes mellitus have clinically significant hepatic fibrosis, the greater risk of progression to cirrhosis decompensation in people with both NAFLD and diabetes mellitus has important consequences for the future burden of NAFLD‐related disease in Australia, they write in the MJA (link here).

The retrospective cohort study analysed data from 8,006 adults admitted to Queensland hospitals with NAFLD or non-alcoholic steatohepatitis (NASH) between 2009 and 2018.

Three hundred and fifty‐one people (4.4%) experienced decompensated cirrhosis during the follow‐up period.

Of the 6900 people without cirrhosis, 4.5% experienced decompensated cirrhosis within ten years (mean, 0.5% per year).

The risk of progression was almost five times greater for people aged 70 years or older compared to patients in their twenties and thirties. Progression risk was also higher in patients who had extrahepatic cancers (adjusted Hazard Ratio 5.0), history of major cardiovascular events (aHR, 1.9), or diabetes mellitus (aHR, 2.8).

Of the 1106 people with cirrhosis, 32.4%  experienced decompensated cirrhosis within ten years (mean, 5.5% per year; 95% CI, 4.8–6.3% per year). The risk of progression was greater for those with portal hypertension (aHR, 1.8), extrahepatic cancer (aHR, 1.8), or diabetes mellitus (aHR, 1.5).

Compared with people who had neither cirrhosis nor diabetes mellitus, the risk of decompensation was greater for people with cirrhosis (aHR, 10.7) or cirrhosis and diabetes mellitus (aHR, 14.4).

Study investigator Professor Patricia Valery said the rate at which NAFLD progression occurred in people with diabetes and cirrhosis was alarming, with 37% developing liver-related complications within a decade.

In patients diagnosed only with diabetes, nearly 10% developed liver-related complications within 10 years, she noted.

“Given the greater risk of developing serious liver complications in people with diabetes, identifying advanced fibrosis and providing appropriate interventions to avert disease progression is vital,” said Professor Valery, leader of of the QIMR Berghofer’s Cancer and Chronic Disease Group.

“We want this data to alert all clinicians to the fact this is a growing problem and while they are managing patients with diabetes, obesity and metabolic syndrome, they also need to be vigilant in screening for NAFLD as well,” she said.

While new diabetes drugs were showing encouraging results in reducing the progression of NAFLD, Professor Valery said improving early recognition of the condition was still paramount.

QIMR Berghofer Clinical Director and hepatologist Professor Elizabeth Powell said Professor Valery’s work would positively impact clinicians in the field as well as other health organisations.

“This research is an important step in documenting the significance of NAFLD which is likely to become an even bigger burden on health care in the future,” she said.