Lean diabetics face higher risk of Fatty Liver Disease
Study throws up surprise finding on diabetics dying from fatty liver disease
Diabetics are three times more likely to die from severe liver disease - fatty liver disease (FLD) being the most common cause - than those without the condition, a local study on over 63,000 Chinese Singaporeans has found.
But the surprise finding was that lean diabetics are at a higher risk than their overweight counterparts to die from FLD.
Diabetes and obesity are known globally to increase the risk of FLD, which occurs when fat accumulates in the organ. It then becomes scarred and cannot function properly.
"At first, I thought it could be a double-whammy - overweight people who also have diabetes should have the higher risk," said Professor Koh Woon-Puay, the principle investigator of the study, at a media briefing yesterday.
"But paradoxically, and contrary to my expectations, among lean people, the effects of diabetes increases their risk even more."
More research has to be done to find out why this is the case, though the researchers postulate that it could be due to more aggressive screening of overweight diabetics or individual genetic profiles.
The researchers used data from the Singapore Chinese Health Study, which recruited middle-aged and elderly Chinese living in Singapore between 1993 and 1998, and correlated that with information from the Singapore registry of births and deaths through to the end of 2014.
A total of 5,696 had diabetes, and 16 died from FLD, which is also known as cirrhosis.
In comparison to a person without diabetes and who has a healthy body mass index (BMI) of under 23, an overweight diabetic is three times more likely to die from FLD.
But a diabetic with a healthy BMI has an even higher risk - he is 5.5 times likelier to die from it.
The message is that if you have diabetes, regardless of your BMI, you are at risk of fatty liver disease.Dr George Goh
Prof Koh, who is from Duke-NUS Medical School, said the findings have important implications for Asia, where patients develop diabetes at lower BMI levels compared to the West.
Dr George Goh, the first author of the study, said the findings suggested that diabetics should be more actively screened for liver disease.
"The message is that if you have diabetes, regardless of your BMI, you are at risk of fatty liver disease," said Dr Goh, a consultant at Singapore General Hospital's department of gastroenterology and hepatology.
He is leading an ongoing study of diabetics to screen and assess the severity of FLD among Chinese, Malays and Indians.
The two-year project, which involves 400 patients, will also try to understand the factors that can reduce the development of FLD.
It is estimated that over 400,000 people here are diabetics.
The incidence of FLD is also rising, according to a study by SingHealth doctors.