Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; School of Public Health, Haifa University, Haifa, Israel.
Liver Int. 2013 Oct;33(9):1406-12. doi: 10.1111/liv.12200. Epub 2013 May 8.
BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) is suspected to confer an increased risk for developing type 2 diabetes (DM). However, only a few prospective studies evaluated NAFLD as a predictor for DM, most did not adjust for the full range of potential cofounders and none used an objectively quantified degree of steatosis. Our aim was to evaluate the independent role of NAFLD in predicting the development of pre-DM in a 7-year prospective follow-up of healthy volunteers.
A prospective cohort of a subsample of the Israeli National Health Survey evaluated at baseline and after 7 years by identical protocols. Metabolic parameters and ultrasonographic evidence of NAFLD were evaluated in 213 subjects, without known liver disease or history of alcohol abuse. Exclusion criteria were pre-DM at the baseline survey. Steatosis was quantified by ultrasound with the hepato-renal ultrasound index (HRI).
The study included 141 volunteers (mean age 48.78 ± 9.68, 24.82% with NAFLD) without pre-DM/DM at baseline. Both NAFLD on regular US (OR=2.93, 1.02-8.41 95%CI) and HRI (OR=7.87, 1.83-33.82) were independent predictors for the development of pre-DM, adjusting for age, gender, BMI, family history of DM, baseline insulin, adiponectin and glucose. Further adjustment for physical activity and dietary intake did not weaken the association. Furthermore, NAFLD was a stronger predictor for pre-DM than the metabolic syndrome. Subjects with both NAFLD and glucose ≥89 had 93.3% incidence rate of pre-DM.
Non-alcoholic fatty liver disease is a strong and independent risk factor for pre-DM in the general adult population; thus, NAFLD patients should be classified as a population at risk.
非酒精性脂肪性肝病（NAFLD）被怀疑会增加 2 型糖尿病（DM）的发病风险。然而，只有少数前瞻性研究评估了 NAFLD 作为 DM 的预测因子，大多数研究没有调整所有潜在混杂因素的范围，也没有使用客观量化的脂肪变性程度。我们的目的是在对健康志愿者进行的 7 年前瞻性随访中，评估 NAFLD 在预测前驱糖尿病发展中的独立作用。
一项以色列国家健康调查的亚组前瞻性队列研究，在基线和 7 年后通过相同的方案进行评估。在 213 名无已知肝脏疾病或酗酒史的研究对象中评估了代谢参数和超声检查 NAFLD 的证据。排除标准为基线调查中患有前驱糖尿病。通过超声检查用肝肾超声指数（HRI）定量评估脂肪变性。
本研究纳入了 141 名志愿者（平均年龄 48.78±9.68 岁，24.82%有 NAFLD），基线时无前驱糖尿病/糖尿病。常规 US 上的 NAFLD（OR=2.93，1.02-8.41 95%CI）和 HRI（OR=7.87，1.83-33.82）均为前驱糖尿病发展的独立预测因素，调整了年龄、性别、BMI、DM 家族史、基线胰岛素、脂联素和血糖。进一步调整体力活动和饮食摄入并未削弱这种关联。此外，NAFLD 是前驱糖尿病的预测因子，比代谢综合征更强。同时患有 NAFLD 和血糖≥89 的患者前驱糖尿病的发生率为 93.3%。
非酒精性脂肪性肝病是普通成年人群中前驱糖尿病的一个强有力且独立的危险因素；因此，NAFLD 患者应被归类为高危人群。
