The liver has many important functions in the body, including storing fat and sugar. Fatty liver is when the liver has stored too much fat. Type 2 diabetes and fatty lever are both part of the metabolic syndrome and share several risk factors for developing cardiovascular disease.
This is really an important collaboration between primary care and specialist care; the gastrointestinal clinic, the radiology clinic, CMIV, the cardiology clinic and diabetes specialists in primary care.
It has long been known that visceral adipose tissue is associated with the development of cardiovascular disease (CVD). Ectopic fat accumulation in the liver can lead to inflammation and progressive fibrosis and is defined as Non-Alcoholic Fatty Liver Disease (NAFLD). This is the most common liver disease today. The most common cause of mortality in NAFLD is CVD. This project is called EPSONiP – Evaluating the Prevalence and Severity of NAFLD in Primary Care and Mattias Ekstedt, Associate professor and Senior Consultant at the Gastrointestinal Clinic, is the Principal Investigator.
The goal is to include 400 patients from four different health care units within the region. This is done with the help of diabetes nurses, who ask patients when they come for their regular diabetes checkup if they want to participate in the study. The project group expects that this cohort will reflect the general diabetes patient in Sweden.
The data collection consists of several blood tests, blood and urine sample that will be saved in a biobank, surveys and fitness tests, among others how far you can walk in 6 minutes.
At a later visit, they will perform a magnetic resonance imaging (MRI) exam at Vrinnevi, Norrköping or at the university hospital in Linköping. Half of the cohort i.e., 200 patients will also perform a heart exam in the MR scanner. That examination is much more advanced and is therefore only done at CMIV.
However, all patients do an MR liver exam and an MR full body exam to look at body composition and distribution of fat and muscles. Main issue is to investigate if they have fatty liver and also the degree of damage to the liver.
Scarring can be divided into five stages, the most serious of which is cirrhosis.
- We are also interested in seeing what it looks like with fat storage in other organs, such as muscles, pancreas and around the heart, Mattias Ekstedt explains.
They also look at how the fat is distributed in different fat depots, in the abdomen and hips. Both men and women are included, 35 - 70 years regardless of how long they have been ill with type 2 diabetes.
- One of the primary goals was to connect all those locally, who are interested in fat storage, and the network is important, Mattias explains.
- This is really a collaboration between primary care and specialist care; the gastrointestinal clinic, the radiology clinic, CMIV, the cardiology clinic and diabetes in primary care, he continues.
A follow-up study in three years is planned to see the progress of liver change.
The aim is to learn how the primary care will identify the patients who are at risk of advanced liver disease. Next is then to understand which patients may develop severe liver disease and this will become important in the three-year follow-up.
The third purpose is to understand how fatty liver affects the development of other disease states such as cardiovascular disease and kidney disease.
There are conflicting results, which makes the study even more exciting.
There are data that indicate that patients with type 2 diabetes together with fatty liver tend to have more changes in their coronary arteries and hence a higher risk profile of developing cardiovascular disease.
At the same time, there are other data that show that fatty liver does not increase the risk of having a heart attack.
The research group is collaborating with the health economy researchers to look at different models for when it is cost-effective to use MRI and when it is better to use, for example, ultrasound.
The EPSONiP-trial is truly a translational multi-disciplinary research project bringing researchers together. This project has the potential to be the starting point for a dynamic research network that will produce interesting scientific results for many years to come.
Nasr, P., Iredahl, F., Dahlström, N. et al.
Evaluating the prevalence and severity of NAFLD in primary care: the EPSONIP study protocol. BMC Gastroenterol 21, 180 (2021). https://doi.org/10.1186/s12876-021-01763-z