Association of non‐alcoholic fatty liver disease with diabetic retinopathy in type 2 diabetic patients: A meta‐analysis of observational studies

Song, Dekun; Li, Chengqian; Wang, Zhongchao; Zhao, Yuhang; Shen, Baoming; Zhao, Wenjuan

doi:10.1111/jdi.13489

Cited by 28 publications

(34 citation statements)

References 38 publications

(67 reference statements)

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“…Fetuin-A has also been found to accelerate incorporation of exogenous fatty acids into cellular triglycerides and cholesterol efflux from cells [ 7 ], yet no substantial correlation between fetuin-A and cholesterol or triglycerides could be observed in our study, and the adjustment for these confounders did not essentially alter the estimates. Some studies suggested increased levels of fetuin-A in NAFLD [ 36 ], inverse [ 39 , 40 ] or positive associations [ 41 , 42 ] between NAFLD and vascular complications in diabetes patients. We did not detect any effect modification by FLI, and fetuin-A only weakly correlated with FLI.…”

Section: Discussionmentioning

confidence: 99%

Fetuin-A and risk of diabetes-related vascular complications: a prospective study

Birukov

Polemiti

Jäger

et al. 2022

Cardiovasc Diabetol

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Background Fetuin-A is a hepatokine which has the capacity to prevent vascular calcification. Moreover, it is linked to the induction of metabolic dysfunction, insulin resistance and associated with increased risk of diabetes. It has not been clarified whether fetuin-A associates with risk of vascular, specifically microvascular, complications in patients with diabetes. We aimed to investigate whether pre-diagnostic plasma fetuin-A is associated with risk of complications once diabetes develops. Methods Participants with incident type 2 diabetes and free of micro- and macrovascular disease from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort (n = 587) were followed for microvascular and macrovascular complications (n = 203 and n = 60, respectively, median follow-up: 13 years). Plasma fetuin-A was measured approximately 4 years prior to diabetes diagnosis. Prospective associations between baseline fetuin-A and risk of complications were assessed with Cox regression. Results In multivariable models, fetuin-A was linearly inversely associated with incident total and microvascular complications, hazard ratio (HR, 95% CI) per standard deviation (SD) increase: 0.86 (0.74; 0.99) for total, 0.84 (0.71; 0.98) for microvascular and 0.92 (0.68; 1.24) for macrovascular complications. After additional adjustment for cardiometabolic plasma biomarkers, including triglycerides and high-density lipoprotein, the associations were slightly attenuated: 0.88 (0.75; 1.02) for total, 0.85 (0.72; 1.01) for microvascular and 0.95 (0.67; 1.34) for macrovascular complications. No interaction by sex could be observed (p > 0.10 for all endpoints). Conclusions Our data show that lower plasma fetuin-A levels measured prior to the diagnosis of diabetes may be etiologically implicated in the development of diabetes-associated microvascular disease.

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Section: Discussionmentioning

confidence: 99%

Fetuin-A and risk of diabetes-related vascular complications: a prospective study

Birukov

Polemiti

Jäger

et al. 2022

Cardiovasc Diabetol

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“…NAFLD affects more than 25% of the global population [ 20 ] and is largely demonstrated as highly prevalent in patients with T2DM (60–75%) [ 21 ]. Many studies proved that NAFLD is associated with an increased risk of macro- and micro-vascular complications in diabetic patients [ 22 , 23 , 24 ], notably including albuminuria [ 25 ] and retinopathy [ 26 ]. Currently, there is little information about the association between NAFLD and DPN, and the available data are scarce and conflicting.…”

Section: Introductionmentioning

confidence: 99%

Association of Nonalcoholic Fatty Liver Disease (NAFLD) with Peripheral Diabetic Polyneuropathy: A Systematic Review and Meta-Analysis

Greco

Nascimbeni

Carubbi

et al. 2021

JCM

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Aims. The relationship between nonalcoholic fatty liver disease (NAFLD) and diabetic polyneuropathy (DPN) has been demonstrated in many studies, although results were conflicting. This meta-analysis aims to summarize available data and to estimate the DPN risk among NAFLD patients. Materials and methods. We performed a comprehensive literature review until 4 June 2021. Clinical trials analyzing the association between NAFLD and DPN were included. Results. Thirteen studies (9614 participants) were included. DPN prevalence was significantly higher in patients with NALFD, compared to patients without NAFLD (OR (95%CI) 2.48 (1.42–4.34), p = 0.001; I2 96%). This finding was confirmed in type 2 diabetes (OR (95%CI) 2.51 (1.33–4.74), p = 0.005; I2 97%), but not in type 1 diabetes (OR (95%CI) 2.44 (0.85–6.99), p = 0.100; I2 77%). Also, body mass index and diabetes duration were higher in NAFLD subjects compared to those without NAFLD (p < 0.001), considering both type 2 and type 1 diabetes. Conclusion. Despite a high heterogeneity among studies, a significantly increased DPN prevalence among type 2 diabetes subjects with NAFLD was observed. This result was not found in type 1 diabetes, probably due to the longer duration of disease. Physicians should pay more attention to the early detection of DPN, especially in patients with NAFLD.

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“…Some cross-sectional studies have investigated the relationship between NAFLD (as detected by imaging techniques) and the risk of prevalent diabetic retinopathy in patients with T2DM, reporting inconsistent results [44,51]. In this regard, a 2021 metaanalysis of nine cross-sectional studies for a total of 7170 patients with T2DM (57% with NAFLD on ultrasonography) reported no association between NAFLD and risk of prevalent diabetic retinopathy (random-effects odds ratio 0.94, 95% confidence interval 0.51-1.71; I 2 = 96%) [52]. In addition, in that meta-analysis, subgroup analyses suggested that in China, Korea and Iran, T2DM patients with NAFLD had a decreased risk of diabetic retinopathy when compared with those without NAFLD, whereas in Italy and India, T2DM patients with NAFLD had an increased risk [52].…”

Section: Diabetic Retinopathymentioning

confidence: 99%

Non-Alcoholic Fatty Liver Disease and Risk of Macro- and Microvascular Complications in Patients with Type 2 Diabetes

Mantovani

Dalbeni

Beatrice

et al. 2022

JCM

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Non-alcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of metabolic syndrome. To date, NAFLD is the most frequent chronic liver disease seen day by day in clinical practice across most high-income countries, affecting nearly 25–30% of adults in the general population and up to 70% of patients with T2DM. Over the last few decades, it clearly emerged that NAFLD is a “multisystemic disease” and that the leading cause of death among patients with NAFLD is cardiovascular disease (CVD). Indeed, several observational studies and some meta-analyses have documented that NAFLD, especially its advanced forms, is strongly associated with fatal and non-fatal cardiovascular events, as well as with specific cardiac complications, including sub-clinical myocardial alteration and dysfunction, heart valve diseases and cardiac arrhythmias. Importantly, across various studies, these associations remained significant after adjustment for established cardiovascular risk factors and other confounders. Additionally, several observational studies and some meta-analyses have also reported that NAFLD is independently associated with specific microvascular conditions, such as chronic kidney disease and distal or autonomic neuropathy. Conversely, data regarding a potential association between NAFLD and retinopathy are scarce and often conflicting. This narrative review will describe the current evidence about the association between NAFLD and the risk of macro- and microvascular manifestations of CVD, especially in patients with T2DM. We will also briefly discuss the biological mechanisms underpinning the association between NAFLD and its advanced forms and macro- and microvascular CVD.

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Association of non‐alcoholic fatty liver disease with diabetic retinopathy in type 2 diabetic patients: A meta‐analysis of observational studies

Cited by 28 publications

References 38 publications

Fetuin-A and risk of diabetes-related vascular complications: a prospective study

Fetuin-A and risk of diabetes-related vascular complications: a prospective study

Association of Nonalcoholic Fatty Liver Disease (NAFLD) with Peripheral Diabetic Polyneuropathy: A Systematic Review and Meta-Analysis

Non-Alcoholic Fatty Liver Disease and Risk of Macro- and Microvascular Complications in Patients with Type 2 Diabetes

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