​A study in Singapore has found an association between diabetes and risk of death from liver cirrhosis, or end-stage liver disease where liver dysfunction is evident, amongst Chinese people. The study has also found that patients with diabetes who are lean may have a higher risk of death from cirrhosis caused by fatty liver disease as compared to heavier patients with diabetes.

This research, led by Professor Koh Woon Puay of Duke-NUS Medical School (Duke-NUS) and Dr George Goh, Consultant, Department of Gastroenterology and Hepatology, Singapore General Hospital (SGH), was conducted using data from the Singapore Chinese Health Study, a prospective study that recruited about 63,000 middle-aged and elderly Chinese living in Singapore between 1993 and 1998.

Up to the end of 2014, over an average 17 years of follow-up, 133 deaths from cirrhosis were identified in this cohort. Participants with a history of diabetes at recruitment had an approximately three-fold risk of cirrhosis death compared to those without diabetes.

Among those without diabetes, those considered overweight were found to have increased risk of cirrhosis death from fatty liver disease compared to those who were lean. However, among participants with diabetes, those who were lean had an increased risk for cirrhosis death from fatty liver disease compared to those who were overweight. Specifically, the risk of death from fatty liver disease increased 3-fold for patients who were both diabetic and overweight, but the risk was highest at 5.5 times among those who were diabetic but lean.

Prof Koh Woon Puay (L) and Dr George Goh (R) have found that lean patients with diabetes have the highest risk of  cirrhosis death from fatty liver disease.

"Obesity remains a risk-factor, but the effect of diabetes in lean patients in relation to fatty liver cirrhosis mortality is paradoxically higher than that in overweight patients. The underlying reason for a higher risk of fatty liver disease related death among lean patients with diabetes has not been ascertained. Nonetheless, it is important that patients with diabetes be actively screened for liver disease, in addition to other known complications," added Dr Goh.

"We expect the increase in diabetes to become the most important factor in driving an increase in fatty liver disease among Singaporeans. Our finding of this mortality risk being higher in lean diabetic patients has important implications in Singapore and other Asian populations, where patients develop diabetes at lower BMI levels compared to Western populations," said senior author, Prof Koh.