Category: Other -

Monitor: 11

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

Friday, Apr 26
11:30 AM – 12:00 PM

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.

SHORT URL FUNCTION-->

Prathyusha V. Chitrapu

Endocrinology Fellow
Baylor College of Medicine
Houston, Texas

I completed my undergraduate training in Biochemistry at UT Dallas, finished my medical school at Texas A&M College of Medicine, and my residency at University of Texas Medical Branch in Galveston. I am currently in my second year of Endocrinology fellowship at Baylor College of Medicine.

Shilpa Jain

Assistant professor
Baylor College of Medicine
HOUSTON, Texas

Experienced Assistant Professor with a demonstrated history of working in the higher education industry. Skilled in Clinical Research, Medical Education, Epidemiology, Oncology, and Medicine. Strong education professional with a MD focused in Pathology from Lady Harding Medical College.

Aaron P. Thrift

Assistant Professor
Baylor College of Medicine
Houston, Texas

I am a cancer epidemiologist with research interests in cancer control, prevention and survivorship, particularly aiming to develop strategies to reduce the population burden of cancer. Within these fields of research, I have a special interest and growing expertise in building statistical models to understand cancer etiology and prognosis, developing risk prediction models for cancer and pre-cancer, and using Mendelian randomization methods to assess causal associations in observational data. My current research into the genetic and environmental causes of Barrett’s esophagus and esophageal cancer aims to stimulate a significant change in clinical practice towards an evidence-based approach and individualized targeted interventions and treatments for disease prevention.

Maya Balakrishnan

Assistant professor
Baylor College of Medicine

I am an academic gastroenterologist/Hepatologist interested in metabolic disease and the liver.

Ruchi Gaba

Asst Prof, Medicine- Endocrinology
Baylor College of Medicine
Houston, Texas

I am currently working as an Assistant Professor in the Division of Endocrinology, Diabetes and Metabolism at Baylor College of Medicine. My clinical interests include Fatty liver disease and I co-manage a NAFLD clinic in collaboration with Gastroenterology. I provide comprehensive care for the metabolic aspects of fatty liver patients with poorly controlled diabetes,metabolic syndrome and lipid disorders.

Prathyusha V. Chitrapu

Endocrinology Fellow
Baylor College of Medicine
Houston, Texas

I completed my undergraduate training in Biochemistry at UT Dallas, finished my medical school at Texas A&M College of Medicine, and my residency at University of Texas Medical Branch in Galveston. I am currently in my second year of Endocrinology fellowship at Baylor College of Medicine.