An association of large-fibre peripheral nerve dysfunction with non-invasive measures of liver fibrosis secondary to non-alcoholic fatty liver disease in diabetes

Kathryn H Williams; Kharis Burns; Maria Constantino; Nicholas A Shackel; Emilia Prakoso; Jencia Wong; Ted Wu; Jacob George; Geoffrey W McCaughan; Stephen M Twigg

doi:10.1016/j.jdiacomp.2015.06.015

An association of large-fibre peripheral nerve dysfunction with non-invasive measures of liver fibrosis secondary to non-alcoholic fatty liver disease in diabetes

J Diabetes Complications. 2015 Nov-Dec;29(8):1240-7. doi: 10.1016/j.jdiacomp.2015.06.015. Epub 2015 Jul 3.

Authors

Affiliations

¹ Central Clinical School, Room 408, Blackburn Building D06, The University of Sydney, New South Wales, Australia, 2006; Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, Australia, 2050; Charles Perkins Centre and Bosch Institute, Building D17, The University of Sydney, New South Wales, Australia, 2006. Electronic address: kath.williams@sydney.edu.au.
² Central Clinical School, Room 408, Blackburn Building D06, The University of Sydney, New South Wales, Australia, 2006; Westmead Hospital, Cnr Darcy Road and Bridge Street, Westmead, NSW, Australia, 2145. Electronic address: kbur9770@uni.sydney.edu.au.
³ Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, Australia, 2050. Electronic address: Maria.Constantino@sswahs.nsw.gov.au.
⁴ Central Clinical School, Room 408, Blackburn Building D06, The University of Sydney, New South Wales, Australia, 2006; Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, Australia, 2050; Centenary Institute, Locked Bag 9, Newtown, New South Wales, Australia, 2042. Electronic address: n.shackel@centenary.usyd.edu.au.
⁵ Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, Australia, 2050; Centenary Institute, Locked Bag 9, Newtown, New South Wales, Australia, 2042. Electronic address: e.prakoso@centenary.org.au.
⁶ Central Clinical School, Room 408, Blackburn Building D06, The University of Sydney, New South Wales, Australia, 2006; Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, Australia, 2050. Electronic address: jencia.wong@sswahs.nsw.gov.au.
⁷ Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, Australia, 2050. Electronic address: Ted.Wu@sswahs.nsw.gov.au.
⁸ Central Clinical School, Room 408, Blackburn Building D06, The University of Sydney, New South Wales, Australia, 2006; Westmead Hospital, Cnr Darcy Road and Bridge Street, Westmead, NSW, Australia, 2145; Westmead Millennium Institute for Clinical Research, P.O. Box 412, Westmead, New South Wales, Australia, 2145. Electronic address: jacob.george@sydney.edu.au.
⁹ Central Clinical School, Room 408, Blackburn Building D06, The University of Sydney, New South Wales, Australia, 2006; Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, Australia, 2050; Centenary Institute, Locked Bag 9, Newtown, New South Wales, Australia, 2042. Electronic address: g.mccaughan@centenary.org.au.
¹⁰ Central Clinical School, Room 408, Blackburn Building D06, The University of Sydney, New South Wales, Australia, 2006; Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, Australia, 2050; Charles Perkins Centre and Bosch Institute, Building D17, The University of Sydney, New South Wales, Australia, 2006. Electronic address: stephen.twigg@sydney.edu.au.

PMID: 26297218
DOI: 10.1016/j.jdiacomp.2015.06.015

Abstract

Aim: To examine for an association of elevated lower-limb vibration perception threshold (VPT) with NAFLD fibrosis.

Methods: Two cohorts from a tertiary diabetes centre were studied - Cohort 1, n=456 with type 1 or 2 diabetes, and Cohort 2, n=106 with type 2 diabetes mellitus. All underwent a detailed assessment, including VPT measurement. Cohort 2 also had liver ultrasound and transient elastography (TE). NAFLD Fibrosis Score (NFS) was calculated for all with available data. Follow-up VPT measurements on participants in Cohort 1 to 2014 were also collected if available.

Results: Adjusted risk of higher VPT category (≥25V but <50V, or ≥50V, c.f. < 25V) was greater for high-risk NFS in both cohorts (Cohort 1, OR 2.22 [95% CI 1.24-3.98, p=0.007] and Cohort 2, OR 4.51 [95% CI 1.08-18.87], p=0.039) and higher liver stiffness measurement (LSM) by TE in Cohort 2 (OR for each unit natural log increase in LSM of 2.42 (95% CI 1.13-5.19), p=0.023). In Cohort 1, in those with VPT<50V and complete data, those with higher NFS had greater odds of increasing VPT category after 2.2 (IQR 1.5-2.9) years.

Conclusions: Higher VPT associates with markers of liver fibrosis due to NAFLD in diabetes mellitus.

Keywords: Diabetes; Fibrosis; NAFLD; NAFLD fibrosis score; Peripheral neuropathy; Transient elastography.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Biomarkers
Cohort Studies
Diabetes Mellitus, Type 1 / complications*
Diabetes Mellitus, Type 2 / complications*
Diabetic Neuropathies / complications*
Diabetic Neuropathies / diagnosis
Diabetic Neuropathies / epidemiology
Diabetic Neuropathies / physiopathology
Elasticity Imaging Techniques
Female
Follow-Up Studies
Foot
Humans
Liver / diagnostic imaging
Liver / physiopathology*
Liver Cirrhosis / etiology
Male
Middle Aged
New South Wales / epidemiology
Non-alcoholic Fatty Liver Disease / complications*
Non-alcoholic Fatty Liver Disease / diagnostic imaging
Non-alcoholic Fatty Liver Disease / epidemiology
Non-alcoholic Fatty Liver Disease / physiopathology
Peripheral Nerves / physiopathology*
Risk Factors
Sensory Thresholds
Severity of Illness Index
Vibration

Substances

Biomarkers