Non-alcoholic fatty liver disease (NAFLD) is significantly associated with metabolic syndrome and insulin resistance with a prevalence of 69–87 % in the setting of diabetes. NAFLD is independently associated with cardiovascular disease, coronary artery stenosis and cardiovascular events in patients with diabetes. Therefore, diagnosis of NAFLD in patients with diabetes may require aggressive cardiovascular risk factor modification and in turn targeted therapy for NAFLD. The current study evaluated whether severity of NAFLD and liver fibrosis quantitatively assessed in individuals with diabetes mellitus (DM)-2 associated with increased risk of coronary heart disease (CHD) with the help of non-invasive markers.

The study enrolled 100 consecutive diabetic individuals without known CHD between March 2013 and September 2014. Out of which, 95 participants were analysed for history, physical examination, serum markers, cardiac computed tomography (CT), magnetic resonance (MR) imaging-estimated proton density fat fraction (PDFF) and MR elastography (MRE). Spearman rank correlation was determined for correlations. Multiple linear regression model was used to assess independent predictors of epicardial adipose tissue (EAT) volume.

The results demonstrated that p value < 0.05 determined statistical significance. The EAT volume was reported to be higher in the NAFLD group, which was identified as MR-imaging PDFF ≥ 5 %, in contrast to the non-NAFLD group (126.5 ml versus 85.4 ml). Moreover, MR imaging-PDFF was associated with EAT. MR imaging-PDFF and liver fibrosis were found to be independently correlated with EAT.

Thus, the study concluded that higher liver fat content and liver fibrosis are independent risk factors for increased cardiovascular risk in diabetics.

Source: Brouha SS, Nguyen P, Bettencourt R, Sirlin CB, Loomba R. Increased severity of liver fat content and liver fibrosis in non-alcoholic fatty liver disease correlate with epicardial fat volume in type 2 diabetes: A prospective study. Eur Radiol. 2018 Apr;28(4):1345-1355.