Glycated haemoglobin may predict disease severity among patients with NAFLD, finds study

Currently, non-invasive scoring systems to stage the severity of non-alcoholic fatty liver disease (NAFLD) do not consider markers of glucose control; this study aimed to define the relationship between HbA1c and non-alcoholic fatty liver disease severity in patients with and without type 2 diabetes. Data were obtained from 857 patients with liver biopsy staged non-alcoholic fatty liver disease.

Paired biopsies from interventional studies were used to assess the impact of change in weight, HbA1c, and active vs. placebo treatment on improvements in steatosis, non-alcoholic steatohepatitis (NASH), and fibrosis.

Results: In the discovery cohort (n = 687), the risk of severe steatosis, non-alcoholic steatohepatitis, and advanced fibrosis correlated positively with HbA1c, after adjustment for obesity and age. Following intervention, reduction in HbA1c was associated with improvements in steatosis and non-alcoholic steatohepatitis after adjustment for weight change and treatment, whilst fibrosis change was only associated with weight change and treatment.

HbA1c is highly informative in predicting non-alcoholic fatty liver disease severity and contributes more than BMI. Assessments of HbA1c must be a fundamental part of the holistic assessment of patients with non-alcoholic fatty liver disease and, alongside age, can be used to identify patients with highest risk of advanced disease.

Reference: Santo Colosimo, Hamish Miller, Dimitrios A. Koutoukidis, Thomas Marjot, Garry D. Tan, David J. Harman, Guruprasad P. Aithal, Pinelopi Manousou, Roberta Forlano, Richard Parker, David A. Sheridan, Philip N. Newsome, William Alazawi, Jeremy F. Cobbold, Jeremy W. Tomlinson. Glycated haemoglobin is a major predictor of disease severity in patients with NAFLD, Diabetes Research and Clinical Practice, 2024, 111820, ISSN 0168-8227, https://doi.org/10.1016/j.diabres.2024.111820.