The Ultrasonographic Correlation of Hepatic Steatosis with Hypertension and Diabetes Mellitus
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Abstract
Background: Hepatic steatosis, commonly known as fatty liver disease, represents a significant public health challenge, increasingly associated with metabolic syndromes such as hypertension and Type 2 Diabetes Mellitus (T2DM). This study investigates the prevalence of hepatic steatosis via ultrasonography and its correlations with hypertension and T2DM in a diverse patient cohort in Pakistan.
Objective: To elucidate the prevalence of hepatic steatosis detected through ultrasonography and its association with hypertension and diabetes mellitus among patients at a teaching hospital in Lahore, Pakistan.
Methods: Conducted from March 2023 to January 2024, this cross-sectional analysis involved 850 patients from the University of Lahore Teaching Hospital's radiology department. Utilizing non-purposive convenience sampling, individuals with critical conditions, trauma, significant alcohol consumption, or a history of specific liver diseases were excluded. Diagnostic criteria for hypertension and diabetes mellitus were based on standard blood pressure and glucose level thresholds, respectively. Abdominal ultrasonography was employed to identify hepatic steatosis. Statistical analysis was executed using SPSS version 16.0, with the Fisher exact test determining significant associations.
Results: Hepatic steatosis was present in 340 (40%) of the patients. Age distribution showed a pronounced prevalence in individuals aged 40-60 years, with 175 patients (51.5% of those with hepatic steatosis) falling within this range. The gender split was relatively even, debunking any significant gender predisposition in this cohort. Among the hepatic steatosis group, hypertension was diagnosed in 204 patients (60%), and T2DM was identified in 230 patients (67.6%). These figures starkly contrast with the non-steatotic group, where hypertension and T2DM prevalences were 30% and 28.9%, respectively, suggesting a strong correlation between hepatic steatosis and these metabolic conditions. Notably, the average age of patients with hepatic steatosis was 44.65 ± 18.8 years.
Conclusion: The study underscores a significant association between hepatic steatosis and the concurrent diagnoses of hypertension and diabetes mellitus, accentuating the condition's prevalence in middle-aged individuals. These findings highlight the critical need for integrated screening programs, encompassing ultrasonographic hepatic assessments in patients diagnosed with or at risk for metabolic syndromes, to facilitate early intervention and prevent progression.
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References
Soresi M, Giannitrapani L, Noto D, Terranova A, Campagna ME, Cefalù AB, Giammanco A, Montalto G. Effects of steatosis on hepatic hemodynamics in patients with metabolic syndrome. Ultrasound Med Biol. 2015 Jun;41(6):1545-52.
Bellentani S, Scaglioni F, Marino M, Bedogni G. Epidemiology of non-alcoholic fatty liver disease. Dig Dis. 2010;28(1):155-61.
Tevar AD, Clarke C, Wang J, Rudich SM, Woodle SE, Lentsch AB, Edwards ML. Clinical review of nonalcoholic steatohepatitis in liver surgery and transplantation. J Am Coll Surg. 2010 Apr;210(4):515-26.
Starley BQ, Calcagno CJ, Harrison SA. Nonalcoholic fatty liver disease and hepatocellular carcinoma: a weighty connection. Hepatology. 2010 May;51(5):1820-32.
Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med. 2011 Dec;43(8):617-49.
Gerstenmaier JF, Gibson RN. Ultrasound in chronic liver disease. Insights Imaging. 2014 Aug;5:441-55.
Hamer OW, Aguirre DA, Casola G, Lavine JE, Woenckhaus M, Sirlin CB. Fatty liver: imaging patterns and pitfalls. Radiographics. 2006 Nov;26(6):1637-53.
Wang CC, Tseng TC, Hsieh TC, Hsu CS, Wang PC, Lin HH, Kao JH. Severity of fatty liver on ultrasound correlates with metabolic and cardiovascular risk. Kaohsiung J Med Sci. 2012 Mar;28(3):151-60.
Targher G, Chonchol M, Zoppini G, Abaterusso C, Bonora E. Risk of chronic kidney disease in patients with non-alcoholic fatty liver disease: is there a link? J Hepatol. 2011 May;54(5):1020-9.
Ferrannini E, Buzzigoli G, Bonadonna R, Giorico MA, Oleggini M, Graziadei L, Pedrinelli R, Brandi L, Bevilacqua S. Insulin resistance in essential hypertension. N Engl J Med. 1987 Aug 6;317(6):350-7.
Pollare T, Lithell H, Berne C. Insulin resistance is a characteristic feature of primary hypertension independent of obesity. Metabolism. 1990 Feb;39(2):167-74.
Laakso M, Edelman SV, Brechtel G, Baron AD. Decreased effect of insulin to stimulate skeletal muscle blood flow in obese man. A novel mechanism for insulin resistance. J Clin Invest. 1990 Jun;85(6):1844-52.
Sabir N, Sermez Y, Kazil S, Zencir M. Correlation of abdominal fat accumulation and liver steatosis: importance of ultrasonographic and anthropometric measurements. Eur J Ultrasound. 2001 Dec;14(2-3):121-8.
Targher G, Day CP, Bonora E. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. N Engl J Med. 2010 Sep 30;363(14):1341-50.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010 Jan;33(Supplement_1):S62-9.
López-Suárez A, Guerrero JM, Elvira-González J, Beltrán-Robles M, Cañas-Hormigo F, Bascuñana-Quirell A. Nonalcoholic fatty liver disease is associated with blood pressure in hypertensive and nonhypertensive individuals from the general population with normal levels of alanine aminotransferase. Eur J Gastroenterol Hepatol. 2011 Nov;23(11):1011-7.
Shih CI, Wu KT, Hsieh MH, Yang JF, Chen YY, Tsai WL, Chen WC, Liang PC, Wei YJ, Tsai PC, Hsu PY. Severity of fatty liver is highly correlated with the risk of hypertension and diabetes: a cross-sectional and longitudinal cohort study. Hepatol Int. 2023 Sep 25.
Ryoo JH, Suh YJ, Shin HC, Cho YK, Choi JM, Park SK. Clinical association between non‐alcoholic fatty liver disease and the development of hypertension. J Gastroenterol Hepatol. 2014 Nov;29(11):1926-31.
Donati G, Stagni B, Piscaglia F, Venturoli N, Morselli-Labate AM, Rasciti L, Bolondi L. Increased prevalence of fatty liver in arterial hypertensive patients with normal liver enzymes: role of insulin resistance. Gut. 2004 Jul;53(7):1020.
Ijaz-ul-Haque Taseer LH, Safdar S, Mirbahar AM, Ahmad I. Frequency of non alcoholic fatty liver disease (NAFLD) and its biochemical derangements in Type-2 diabetic patients. Pak J Med Sci. 2009;25(5):817-20.
Luxmi S, Sattar RA, Ara J. Association of non-alcoholic fatty liver with type 2 diabetes mellitus. Jlumhs. 2008 Sep;9:188-93.
Amarapurkar D, Kamani P, Patel N, Gupte P, Kumar P, Agal S, Baijal R, Lala S, Chaudhary D, Deshpande A. Prevalence of non-alcoholic fatty liver disease: population based study. Ann Hepatol. 2007 Jul;6(3):161-3.
Akbar DH, Kawther AH. Nonalcoholic fatty liver disease in Saudi type 2 diabetic subjects attending a medical outpatient clinic: prevalence and general characteristics. Diabetes Care. 2003 Dec;26(12):3351-3.
Targher G, Bertolini L, Padovani R, Rodella S, Tessari R, Zenari L, Day C, Arcaro G. Prevalence of nonalcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients. Diabetes Care. 2007 May;30(5):1212-8.
Williams CD, Stengel J, Asike MI, Torres DM, Shaw J, Contreras M, Landt CL, Harrison SA. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011 Jan;140(1):124-31.
Targher G, Bertolini L, Poli F, Rodella S, Scala L, Tessari R, Zenari L, Falezza G. Nonalcoholic fatty liver disease and risk of future cardiovascular events among type 2 diabetic patients. Diabetes. 2005 Dec;54(12):3541-6.
Abd El-Kader SM, El-Den Ashmawy EM. Non-alcoholic fatty liver disease: The diagnosis and management. World J Hepatol. 2015 Apr 4;7(6):846.
Singer C, Stancu P, Coşoveanu S, Botu A. Non-alcoholic fatty liver disease in children. Curr Health Sci J. 2014 J.