Association of non-alcoholic fatty liver disease with diabetic microvascular and macrovascular complications in South Indian diabetic subjects

Aims: Nonalcoholic fatty liver disease (NAFLD) is a common liver disorder that is strongly associated with insulin resistance and type 2 diabetes. This study was designed to evaluate whether there is an association between NAFLD and diabetic micro- and macrovascular complications among diabetic subjects. Materials and Methods: The subjects were selected from 2161 (M:F; 1187:974) type 2 diabetic patients who had undergone ultrasound of abdomen for assessment of fatty liver. A total of 156 patients with evidence of NAFLD (group 1) were compared with 142 (group 2) patients with normal liver ultrasound and the presence of micro- and macrovascular complications of diabetes were recorded. Multiple logistic regression analysis was performed using NAFLD as the dependent variable. Independent variables included were age, gender, duration of diabetes mellitus (DM), body mass index (BMI), nephropathy, neuropathy, retinopathy, peripheral occlusive vascular disease (POVD), and coronary artery disease (CAD). Results: Prevalence of obesity, hypertension, and dyslipidemia were significantly higher in subjects with NAFLD. They had higher prevalence of retinopathy (29.4 vs. 9.8, P < 0.001), neuropathy (27.5 vs. 10.5, P < 0.001), nephropathy (32 vs. 25, P = 0.2). The prevalence of CAD among NAFLD (11.5 vs. 1.4, P = 0.01) was higher and POVD was similar in both the groups. The results of multiple logistic regression analysis showed that NAFLD was associated with BMI, retinopathy, neuropathy, and CAD. Conclusions: NAFLD as diagnosed by ultrasound was associated with micro- and macrovascular complications of diabetes. The prevalence of obesity, hypertension, and dyslipidemia were significantly higher in subjects with NAFLD.