Original articleNonalcoholic fatty liver disease in patients with type 2 diabetes
Section snippets
Development of the NAFLD database
The NAFLD database was created by looking at liver biopsies processed at the Cleveland Clinic Department of Pathology (Cleveland, OH) from January 1, 1979, to December 31, 1987. Pathological features identified excess fat with or without other pathological findings. Specimens with other causes of liver disease (e.g., alcohol, medication, hepatitis C, iron overload) were systematically excluded.3, 4, 26 Data included a large number of clinical and pathological features, as well as long-term
Identification of the NAFLD cohort
A total of 4238 liver biopsy specimens were processed at the Cleveland Clinic Department of Pathology during the period of this study. Of these, 772 specimens (18%) showed excessive fatty accumulation (± other features) as their primary diagnosis. Specimens with other causes of liver disease were excluded. Specimens from the remaining 157 patients (3.7%) fulfilled criteria for the final diagnosis of NAFLD. Of these, 132 patients (84%) had complete clinical and pathological data and constituted
Discussion
This analysis indicates that patients with DM and NAFLD have more aggressive disease with respect to cirrhosis and mortality than NAFLD patients without DM. The increased risk remained significant even after adjusting for potentially important confounders that can affect survival. The 18.2% liver-related mortality rate reported here is much greater than that of patients without DM with NAFLD and those reported for the general population.3, 4 Although a number of factors were associated with
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