Frequency of non-alcoholic fatty liver disease and associated risk factors in patients with type 2 diabetes mellitus and diabetic foot ulcer

Objectives: Many studies have demonstrated a higher prevalence of non-alcoholic fatty liver disease (NAFLD) in individuals who are overweight, obese, or have type 2 diabetes mellitus (T2DM). Diabetic foot ulcers (DFUs) are a serious complication resulting from chronic micro and macrovascular complications of diabetes mellitus (DM). They can increase the risk of amputation and mortality rate due to the catabolic processes that they trigger. Numerous factors that may be associated with the frequency and prognosis of NAFLD in individuals with T2DM are still being investigated. We were unable to find any studies in the literature on the prevalence of NAFLD in T2DM individuals with DFU. This study was designed with the consideration that the frequency of NAFLD may differ in T2DM individuals with DFU due to increased catabolic processes. Methods: Our study prospectively included 100 individuals with T2DM who were followed up in the endocrinology service for DFU. The study excluded individuals who were under 18 years of age or had T1DM. Liver ultrasound was used to assess the presence and grade of NAFLD. Demographic data, laboratory findings, and body mass index (BMI) of the participants were documented for comparative analysis. Additionally, the participants were categorized into three groups based on their BMI levels (BMI ≤25, 25-30, and ≥30 kg/m2) and compared. Results: The overall NAFLD frequency was found to be 39%, and there was no significant difference in NAFLD frequency between both genders (in men, 42.3%; in women, 35.4%; p = 0.480). Individuals with NAFLD had a significantly higher mean BMI (27.3±3.4) and frequency of hyperlipidemia (59.0%) compared to those without NAFLD (25.6±3.7 and 45.9%, respectively, p<0.001 for both). NAFLD was detected in 15% of individuals with a BMI of ≤25 kg/m2, in 50% of those with a BMI of 25-30 kg/m2, and in 69% of those with a BMI of ≥30 kg/m2. Higher BMI values were associated with an increased risk of NAFLD (p < 0.001). Conclusion: In our study, the frequency of NAFLD and the prevalence of overweight and obese subjects were notably lower than those reported in the current literature for individuals with T2DM. The mean BMI and frequency of hyperlipidemia were higher in individuals with nonX alcoholic fatty liver disease (NAFLD) compared to those without. Additionally there was an association between increasing BMI levels and a higher frequency of NAFLD. Further studies are needed to investigate low BMI levels and the associated risk factors among this group of patients. Key Words: Non-Alcoholic Fatty Liver Disease, Type 2 Diabetes Mellitus, Diabetic Foot Ulcer, Body Mass Index