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How to screen NAFLD patients for diabetes?
Emmanuel I. González-Moreno
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emmanuelgzz@meduanl.com

Correspondence and reprint request:
, Diego García-Compean, José A. González-González, Héctor J. Maldonado-Garza
Gastroenterology Division. Internal Medicine Department. Hospital Universitario “Dr. José Eleuterio González”. Universidad Autónoma de Nuevo León. Monterrey, Mexico
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0005" class="elsevierStylePara elsevierViewall">Dear editor&#58;</p><p id="p0010" class="elsevierStylePara elsevierViewall">We read with great interest the article by Fukuda&#44; <span class="elsevierStyleItalic">et al&#46;</span><span class="elsevierStyleSup">1</span> who found in a population-based retrospective cohort study among 4&#44;629 participants that non-overweight individuals with non-alcoholic fatty liver disease &#40;NAFLD&#41; had a high risk of incident type 2 diabetes mellitus &#40;T2DM&#41;&#46; In developed countries NAFLD is the leading cause of chronic liver disease &#40;CLD&#41;&#44; as data showed that between 1988 to 1994 NAFLD accounted for 46&#46;8&#37; of all CLD&#44; and between 2005 to 2008 it accounted for 75&#46;1&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Fukuda&#44; <span class="elsevierStyleItalic">et al&#46;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> showed that the adjusted hazard ratio for incident T2DM in the non-overweight with NAFLD group was significantly higher than that in the overweight without NAFLD group &#40;P &#60; 0&#46;05&#41; as well as that in the non-overweight without NAFLD group &#40;P &#60; 0&#46;01&#41;&#46; Recently&#44; Koehler&#44; <span class="elsevierStyleItalic">et al&#46;</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> not only demonstrated the important relationship between NAFLD&#47;DM&#44; but also illustrated that DM is closely related with the development of fibrosis&#46; We think an important fact has not been extensively addressed&#59; recently&#44; it has been suggested that NAFLD patients should be screened for DM&#44; however&#44; there is no emphasis about which method should be used&#44; fasting plasma glucose &#40;FPG&#41;&#44; glycosylated hemoglobin &#40;HbA1c&#41;&#44; or oral glucose tolerance test &#40;OGTT&#41;&#46; Fukuda&#44; <span class="elsevierStyleItalic">et al&#46;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> defined T2DM according to an HbA1c &#8805; 6&#46;5&#37; or FPG &#8805; 126 mg&#47;dL&#41; or as the initiation of T2DM treatment&#46; Recent evidence suggests that the best tool for screening NAFLD patients for T2DM is not FPG&#46; In a study by Manchanayake&#44; <span class="elsevierStyleItalic">et al&#46;</span><a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> 70 non-diabetic NAFLD patients underwent OGTT&#46; One-third &#40;34&#37;&#41; of patients had abnormal OGTT &#40;24&#37; impaired glucose tolerance and 10&#37; DM&#41;&#46; Importantly&#44; only 25&#37; of patients with abnormal OGTT had impaired FPG&#46; Although&#44; in this cohort&#44; few patients had liver biopsy&#44; those with abnormal OGTT were more likely to have cirrhosis &#40;13&#37;&#41; than those with normal OGTT &#40;4&#46;5&#37;&#41;&#46; An important step in the management of NAFLD patients is to identify patients at risk to develop non-alcoholic steatohepatitis&#44; and in this context&#44; it seems that NAFLD patients with glucose metabolism alterations are at increased risk&#46; Further large prospective studies should confirm if OGTT is the best way to screen NAFLD patients for DM&#46;</p><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0005">Abbreviations</span><p id="p0015" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0005"><li class="elsevierStyleListItem" id="u0005"><span class="elsevierStyleLabel">&#8226;</span><p id="p0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">CLD&#58;</span> chronic liver disease&#46;</p></li><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">&#8226;</span><p id="p0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">FPG&#58;</span> fasting blood plasma glucose&#46;</p></li><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">&#8226;</span><p id="p0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">NAFLD&#58;</span> non-alcoholic fatty liver disease&#46;</p></li><li class="elsevierStyleListItem" id="u0020"><span class="elsevierStyleLabel">&#8226;</span><p id="p0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">OGTT&#58;</span> oral glucose tolerance test&#46;</p></li><li class="elsevierStyleListItem" id="u0025"><span class="elsevierStyleLabel">&#8226;</span><p id="p0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">T2DM&#58;</span> type 2 diabetes mellitus&#46;</p></li></ul></p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">Conflict of Interest</span><p id="p0045" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest and no financial support to disclose&#46;</p></span></span>"
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Article information
ISSN: 16652681
Original language: English
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2023 December 4 5 9
2023 November 10 5 15
2023 October 11 4 15
2023 September 7 0 7
2023 August 7 3 10
2023 July 12 4 16
2023 June 9 1 10
2023 May 7 4 11
2023 April 5 1 6
2023 March 8 2 10
2023 February 6 1 7
2023 January 8 6 14
2022 December 14 14 28
2022 November 15 10 25
2022 October 4 4 8
2022 September 12 8 20
2022 August 12 10 22
2022 July 10 9 19
2022 June 15 10 25
2022 May 9 9 18
2022 April 10 7 17
2022 March 5 11 16
2022 February 8 8 16
2022 January 10 8 18
2021 December 8 12 20
2021 November 8 4 12
2021 October 6 9 15
2021 September 12 9 21
2021 August 5 7 12
2021 July 7 9 16
2021 June 9 8 17
2021 May 6 5 11
2021 April 12 7 19
2021 March 7 10 17
2021 February 5 6 11
2021 January 5 6 11
2020 December 5 9 14
2020 November 5 7 12
2020 October 4 3 7
2020 September 5 4 9
2020 August 7 6 13
2020 July 4 9 13
2020 June 7 2 9
2020 May 6 5 11
2020 April 1 1 2
2020 March 1 2 3
2020 February 4 5 9
2020 January 5 2 7
2019 December 5 10 15
2019 November 5 2 7
2019 October 0 1 1
2019 September 1 0 1
2019 August 1 1 2
2019 July 1 12 13
2019 June 2 4 6
2019 May 2 3 5
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos