Non alcoholic fatty liver disease and its relationship with hsCRP in type 2 diabetes mellitus

Background: Diabetes mellitus is assuming an epidemic form in India. Non-alcoholic fatty liver disease worldwide is increasing too and is a major cause of liver transplant in the west. Diabetes is a strong risk factor for non-alcoholic fatty liver disease, and some of them go on to develop steatohepatitis which is associated with a more rapid disease progression leading to chronic liver disease including hepatocellular carcinoma. This association of diabetes with fatty liver disease is least investigated. Liver biopsy is not routinely done in clinical practice and various non-invasive markers for fatty liver or steatohepatitis are used frequently to identify patients at risk of fatty liver disease.Methods: 116 Type 2 Diabetics Mellitus on therapy with oral anti-diabetic drugs and atorvastatin for at least 3 months’ duration were included and sonologically evaluated for fatty liver after proper exclusion of other causes of fatty liver. Serum hsCRP, an acute phase reactant, was measured in them. Liver function tests, BMI and other necessary investigations were done. 144 healthy controls were also taken.Results: The absolute risk of developing fatty liver was significantly high in T2 diabetics compared to controls. hsCRP was significantly associated with fatty liver and uncontrolled glycemic status. In addition AST/ALT > 1 also showed significant differences amongst the same groups.Conclusions: High hsCRP is a cheap, easily available laboratory marker to suspect fatty liver and possibly steatohepatitis in T2 Diabetics in our region. It can identify a subgroup of diabetic patients in whom liver biopsy may be advisable to confirm steatohepatitis which is important for prognosis and therefore need aggressive intervention.