الفهرس 
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Abstract
Nonalcoholic fatty liver disease (NAFLD) is characterized by the presence of extra fat in the liver, exceeding 5–10% of liver weight. Most patients with NAFLD have increased liver fat only (simple steatosis). Some of the patients develop hepatic inflammation, a condition known as nonalcoholic. steatohepatitis (NASH), and up to 20% of patients experience progressive hepatic fibrosis and may eventually progress to liver cirrhosis or failure and even hepatocellular carcinoma.
The NAFLD spectrum ranges from simple steatosis to NASH, a progressive necroinflammatory form that can lead to liver cirrhosis and hepatocellular carcinoma. Various inflammatory reactions including oxidative stress, release of proinflammatory cytokines, and lipotoxicity are closely related to development of NASH.
Notwithstanding, the leading cause of death in persons with NAFLD is cardiovascular disease (CVD), presumably due to shared risk factors composing obesity and metabolic syndrome. Previously NAFLD was linked to a higher prevalence of coronary artery disease and subclinical atherosclerosis, demonstrated by increased carotid artery wall thickness and impaired endothelial flow-mediated vasodilatation). In addition, persons with NAFLD had altered left ventricular (LV) geometry and early features of LV diastolic dysfunction by echocardiography.
The presence of concomitant liver fibrosis poses an even greater risk for cardiovascular mortality. So, the aim of this study was to investigate whether hepatic steatosis and fibrosis in T2DM were independently associated with abnormal LV diastolic function.
To elucidate our aim, this study was a cross-sectional study that was conducted on 100 patients in inpatient and outpatient endocrinology clinic, Faculty of Medicine, Menoufia University during the period from July 2020 to October 2021.
The study was included two study population groups including:
group I: included type 2 diabetic patients without Nonalcoholic fatty liver disease (NAFLD) and group II: included diabetic patients with Nonalcoholic fatty liver disease (NAFLD).
All patients included in this study were subjected to the following: All subjects were asked about age, sex, duration of the Diabetes mellitus (DM), medications, history of other disease. General clinical examination: Blood pressure, Weight, height and body mass index (BMI), BMI, Waist circumference, hip circumference and waist-to-hip ratio (WHR). Laboratory investigations as: Fasting plasma glucose, 2hours post prandial plasma glucose, Glycosylated hemoglobin (HbA1c), HOMAIR, Lipid profile: total cholesterol, High density lipoprotein cholesterol (HDL-C), Triglycerides, Visceral Adiposity Index (VAI). Complete blood count (CBC), Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Serum Albumin, Serum Bilirubin (total &direct), IHA for Schistosoma.
The results of this study could be summarized as follow:
Patients in the NAFLD group were more recently diagnosed with T2DM (P=0.025) compared with the non-NAFLD group. There was no significant difference between patients in the NAFLD group and the non-NAFLD group as regards age, sex and treatment (oral antidiabetic drugs or insulin).
While fasting glucose and HbA1c were not significantly difference between the groups, patients with NAFLD exhibited significantly greater insulin resistance(HOMA-IR) (P=0.035) and higher fasting insulin (P=0.028) than patients without NAFLD, and There is no statistically significant difference between studied groups as regards Hb, Platelet, 2HPB.
Serum cholesterol, triglycerides, and liver transaminases were also significantly elevated in the NAFLD patient compared with patients without NAFLD.
Prevalence of LV diastolic dysfunction was significantly higher in the NAFLD patients compared with the patients without NAFLD (64% vs. 40%, P=0.011).
The results of univariate binary logistic regression analysis indicate that Diastolic BP, was the most significant for detection of independent predictors of diastolic dysfunction among the studied group, while weight, Systolic BP, TG, cholesterol, AST, ALT didn’t show any significant.