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Journal of Diabetes Research
Volume 2016 (2016), Article ID 2931985, 9 pages
Research Article

The Burden of NAFLD and Its Characteristics in a Nationwide Population with Type 2 Diabetes

1Unit of Metabolic Diseases and Clinical Dietetics, “Alma Mater Studiorum” University of Bologna, 40138 Bologna, Italy
2Diabetes and Metabolism Unit, ASL Turin 5, 10023 Chieri, Italy
3Unit of Internal Medicine, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
4Center for Outcomes Research and Clinical Epidemiology (CORE), 65124 Pescara, Italy
5Diabetes Unit, AUSL Romagna, 48121 Ravenna, Italy
6Biomedical Research Institute August Pi Sunyer (IDIBAPS) and Center for Biomedical Research in Diabetes and Associated Metabolic Disorders (CIBERDEM), 08036 Barcelona, Spain
7AMD (Italian Association of Clinical Diabetologists), 00192 Rome, Italy

Received 3 November 2015; Revised 25 January 2016; Accepted 29 February 2016

Academic Editor: Daisuke Koya

Copyright © 2016 Gabriele Forlani et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. We studied the prevalence of nonalcoholic fatty liver disease (NAFLD) and its clinical correlates in a population of patients with type 2 diabetes mellitus (T2DM). Methods. Clinical data of 94,577 T2DM patients were retrieved from 160 diabetes clinics in Italy in a standardized format and centrally analyzed anonymously. After exclusion of 5967 cases (high or uncertain alcohol intake), in 38,880 the Fatty Liver Index (FLI) was used as a proxy for the diagnosis of NAFLD. Factors associated with FLI assessed NAFLD (FLI-NAFLD) were evaluated through multivariate analysis. Results. FLI-NAFLD was present in 59.6% of patients. Compared to non-NAFLD, FLI-NAFLD was associated with impairment in renal function, higher albumin excretion, HbA1c and blood pressure, lower HDL cholesterol, and poorer quality of care. ALT was within normal limits in 73.6% of FLI-NAFLD patients (45.6% if the updated reference values were used). The prevalence of FLI-NAFLD did not differ if the whole sample (94,577 cases) was examined, irrespective of alcohol intake. Conclusions. FLI-NAFLD was present in the majority of T2DM patients of our sample and metabolic derangement, not alcohol consumption, was mainly associated with the disease. FLI-NAFLD patients have a worse metabolic profile. ALT levels are not predictive of NAFLD.