SINGAPORE - Diabetics are three times more likely to die from severe liver disease than those without the condition, a local study on over 60,000 Chinese Singaporeans has found.
And the surprise finding is that lean diabetics are at a higher risk than their overweight counterparts to die from fatty liver disease.
The findings were released at a media briefing on Friday (Jan 20).
Diabetes and obesity are known globally to increase the risk of fatty liver disease. This happens when fat accumulates in the organ, it becomes scarred and cannot function properly.
"At first I thought it could be double-whammy, overweight people who also have diabetes should have the higher risk," said Professor Koh Woon-Puay, who is from Duke-NUS Medical School, and principle investigator of the study.
"But paradoxically and contrary to my expectations, among lean people, the effects of diabetes increases their risk even more."
More research has to be done to find out why this is the case.
The researchers used data from the Singapore Chinese Health Study, which recruited middle-aged and elderly Chinese living in Singapore between 1993 and 1998, and correlated that with information from the Singapore registry of births and deaths through to the end of 2014. A total of 5,696 had diabetes, and 16 died from fatty liver disease, which is also known as cirrhosis.
In comparison, to a person without diabetes and who has a healthy body mass index (BMI) of under 23, an overweight diabetic is three times more likely to die from fatty liver disease.
But a diabetic with a healthy BMI has an even higher risk - he is 5.5 times likelier to die from it.
The paper on the findings will be published in the scientific journal Liver International in February.
Prof Koh said the findings have important implications in Singapore and other Asian populations, where patients develop diabetes at lower BMI levels compared to Western populations.
Dr George Goh, a consultant at Singapore General Hospital's department of gastroenterology and hepatology, and first author of the study, said the findings suggest that diabetics should be more actively screened for liver disease, on top of other conditions more commonly associated with diabetes such as heart disease, eye conditions like cataracts and glaucoma, and kidney disease.
"The message is that if you have diabetes, regardless of your BMI, you are at risk of fatty liver disease," he added.
Dr Goh is also leading an ongoing study of diabetic patients to screen and assess the severity of fatty liver disease among the Chinese, Malay and Indian populations. The two-year project, which involves 400 patients and will end in December this year, will also try to understand the factors that can reduce the development of fatty liver disease.
Over 400,000 people here are diabetics, it is estimated. The incidence of non-alcoholic fatty liver disease is also rising in Singapore, according to a study by SingHealth doctors, and could well be affecting half of the adults in the Republic.