An association of large-fibre peripheral nerve dysfunction with non-invasive measures of liver fibrosis secondary to non-alcoholic fatty liver disease in diabetes

AimTo examine for an association of elevated lower-limb vibration perception threshold (VPT) with NAFLD fibrosis.MethodsTwo cohorts from a tertiary diabetes centre were studied - Cohort 1, n = 456 with type 1 or 2 diabetes, and Cohort 2, n = 106 with type 2 diabetes mellitus. All underwent a detailed assessment, including VPT measurement. Cohort 2 also had liver ultrasound and transient elastography (TE). NAFLD Fibrosis Score (NFS) was calculated for all with available data. Follow-up VPT measurements on participants in Cohort 1 to 2014 were also collected if available.ResultsAdjusted risk of higher VPT category (≥ 25 V but < 50 V, or ≥ 50 V, c.f. < 25 V) was greater for high-risk NFS in both cohorts (Cohort 1, OR 2.22 [95% CI 1.24-3.98, p = 0.007] and Cohort 2, OR 4.51 [95% CI 1.08-18.87], p = 0.039) and higher liver stiffness measurement (LSM) by TE in Cohort 2 (OR for each unit natural log increase in LSM of 2.42 (95% CI 1.13-5.19), p = 0.023). In Cohort 1, in those with VPT < 50 V and complete data, those with higher NFS had greater odds of increasing VPT category after 2.2 (IQR 1.5-2.9) years.ConclusionsHigher VPT associates with markers of liver fibrosis due to NAFLD in diabetes mellitus.