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(11) ASSOCIATION OF VITAMIN D LEVELS WITH THE SEVERITY OF FIBROSIS IN NAFLD PATIENTS WITH TYPE 2 DIABETES


Authors:

Prathyusha V. Chitrapu, MD – Endocrinology Fellow, Baylor College of Medicine

Maya Balakrishnan, MD MPH – Assistant professor, Baylor College of Medicine

Shilpa Jain, M.D. – Assistant professor, Baylor College of Medicine

Ruchi Gaba, MD – Asst Prof, Medicine- Endocrinology, Baylor College of Medicine

Aaron P. Thrift, PhD – Assistant Professor, Baylor College of Medicine

Abstract:

Objective : Severity of fibrosis is the strongest predictor of disease specific mortality in patients with NAFLD (nonalcoholic fatty liver disease).Various epidemiological studies have shown that Vitamin D deficiency is commonly found in patients with NAFLD but only a few have examined its association with NAFLD severity.

Methods :

We conducted a prospective cross-sectional study among 69 consecutive patients with biopsy proven NAFLD recruited from Ben Taub Multidisciplinary NAFLD clinic (Baylor College of Medicine, Houston, Texas) between January 2014 and January 2018. All patients were overweight or obese with type 2 diabetes and vitamin D levels less than 30 ng/dl. Modified Brunt Kleiner method was used for staging of steatohepatitis. Severity of fibrosis was assigned between 0-4; advanced fibrosis was defined as F3-4. We estimated odds ratios (OR) and 95% confidence intervals for the association between vitamin D levels and risk of advanced fibrosis using logistic regression models.

Results :

The mean age of the cohort was 48.0 years (standard deviation [SD], 9.6) and majority of patients were female (82.6%). On average, patients with advanced fibrosis were older than those with early fibrosis (53.1 years vs. 45.2 years; p=0.001), but there were no differences in the distributions of sex (p=0.22) and BMI (p=0.94) between the two groups. The mean Vitamin D level among early fibrosis patients was 18.9 (SD, 5.1) compared with 18.6 (SD, 5.8) among patients with advanced fibrosis. In logistic regression models, we found no association between vitamin D level and the risk of advanced fibrosis (unadjusted OR, 0.99; 95% CI, 0.90-1.09; adjusted OR, 0.98; 95% CI, 0.88-1.09).  Age was the only statistically significant predictor of advanced fibrosis (per 1 year increase, adjusted OR, 1.12; 95% CI, 1.04-1.20).

Discussion :

NAFLD is considered a hepatic manifestation of metabolic syndrome (MS) which is often associated with low vitamin D levels. Vitamin D deficiency is frequently found in NAFLD as well, independent of the other components of MS.  But data has been inconsistent when evaluating the specific level of vitamin D affecting the severity of NAFLD. In our analysis we found no association between vitamin D levels and the risk of advanced fibrosis. All the patients had biopsy proven NAFLD and histology was used to stage the fibrosis instead of fibrosis scores or ultrasounds as in most previous studies. In addition they were all overweight or obese with Type 2 DM (possible confounding factors). The main limiting factor was our small sample size.

Conclusion : Our results suggest that the severity of Vitamin D deficiency does not correlate with severity of fibrosis in biopsy proven NAFLD with type 2 diabetes.

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