Clinical availability of nonalcoholic fatty liver disease as an early predictor of type 2 diabetes mellitus in korean men: 5-year prospective cohort study

Abstract

There have been several reports about the clinical association between type 2 diabetes mellitus (DM) and nonalcoholic fatty liver disease (NAFLD). However, most of the studies were about the unilateral effects of type 2 DM on NAFLD, and studies on the reverse relation are rare. Thus, this study was designed to investigate the effect of NAFLD on type 2 DM. We conducted a prospective cohort study on 25,232 Korean men without type 2 DM for 5 years. We serially checked the various metabolic factors including fasting glucose and hemoglobin A1c (HbA1c), and monitored the development of type 2 DM. The incidence rate of type 2 DM was compared according to the degree of NAFLD (normal, mild, and moderate to severe), and a Cox proportional hazards model was used to measure the hazard ratios (HRs) of NAFLD on type 2 DM. The incidence rate of type 2 DM increased according to the degree of NAFLD (normal: 7.0%, mild: 9.8%, moderate to severe: 17.8%, P < 0.001). Even after adjusting for other multiple covariates, the HRs (95% confidence interval [CI]) for type 2 DM development was higher in the mild group (1.09; 0.81-1.48) and moderate to severe group (1.73; 1.00-3.01) compared to the normal group, respectively (P for trend <0.001). Conclusion: The development of type 2 DM is potentially more associated with more progressive NAFLD than a normal or milder state. In addition, NAFLD was an independent risk factor for the future development of type 2 DM. These results suggest the potential availability of NAFLD as an early predictor of type 2 DM. (HEPATOLOGY 2013;57:1378-1383

Independent Association Between Improvement of Nonalcoholic Fatty Liver Disease and Reduced Incidence of Type 2 Diabetes

“…Lonardo et al (2) showed in a systematic review that NAFLD is strongly associated with future metabolic syndrome and T2DM. In addition, several longitudinal studies evaluated the association between NAFLD detected on ultrasound (US) and T2DM (6)(7)(8)(9)(10)(11)(12)(13)(14). Most of these studies observed a significant positive association between NAFLD at baseline and T2DM incidence (6)(7)(8)(9)(10)(11)(12)(13), but longterm cohort studies with a follow-up period of .10 years are limited (14).…”

Risk of type 2 diabetes in patients with non-alcoholic fatty liver disease: Causal association or epiphenomenon?

“…The risk of diabetes among these published studies varied markedly from a 33% increase [14] to a 5.5 fold increase in risk [11]. This wide inter-study variation in risk might reflect differences in NAFLD severity, since the study by Park et al [15] showed that the 5-year incidence rate of type 2 diabetes increased progressively according to the ultrasonographic severity of NAFLD at baseline (normal: 7.0%, mild: 9.8%, moderate-to-severe: 17.8%) in a cohort of 25,232 South Korean nondiabetic middle-aged men. Even after adjusting for multiple confounding variables, the hazard ratios (HRs) for diabetes development were higher in the mild-NAFLD group (adjusted-HR 1.09; 95% confidence interval [CI] 0.81-1.48) and in the moderate-to-severe-NAFLD group (adjusted-HR 1.73; 95% CI 1.00-3.01) compared with the no-NAFLD group, respectively.…”

“…There are now about 20 observational studies that have assessed the association between NAFLD and the risk of new-onset type 2 diabetes [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”

“…Collectively, although there is now convincing evidence that NAFLD is associated with an increased risk of new-onset type 2 diabetes [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25], and there is emerging evidence that this risk varies according to the severity of NAFLD (as detected either by ultrasonography or by use of non-invasive fibrosis scoring systems) [9,[12][13][14], further evidence is unquestionably needed in non-Asian populations, as nearly all of the studies summarised in Table 1 have been conducted in various Asian populations, and most of the evidence obtained to date has been obtained in South Korean individuals. However, a recent analysis from the Multi-Ethnic Study of Atherosclerosis study involving more than 3,000 United States nondiabetic individuals has confirmed that NAFLD as detected by computed tomography was independently associated with a two-fold increased risk of developing type 2 diabetes [25].…”

The relationship between hepatitis C virus infection and diabetes: Time for a divorce?

“…17,19 and several large, longitudinal studies recognize hepatic steatosis as a risk factor for development of T2DM. 20,21 Finally, the little effect of active HCV infection on HOMA-IR within groups of normal or elevated ALT (as well as GGT; see Fig. 3A,B of the article), when compared to HCV2 patients, suggest that the multiple potential mechanisms for HCV-induced hepatic insulin resistance (HIR) appear to have no clinical relevance, at least in community-based populations with HCV infection.…”