Division of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul 110-746, Republic of Korea.
J Clin Endocrinol Metab. 2013 Sep;98(9):3637-43. doi: 10.1210/jc.2013-1519. Epub 2013 Jul 19.
Fatty liver is associated with an increased risk of type 2 diabetes, but whether an increased risk remains in people in whom fatty liver resolves over time is not known.
The objective of the study was to assess the risk of incident diabetes at a 5-year follow-up in people in whom: 1) new fatty liver developed; 2) existing fatty liver resolved, and 3) fatty liver severity worsened over 5 years.
A total of 13,218 people without diabetes at baseline from a Korean occupational cohort were examined at baseline and after 5 years, using a retrospective study design. Fatty liver status was assessed at baseline and follow-up as absent, mild, or moderate/severe using standard ultrasound criteria. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for incident diabetes at follow-up were estimated after controlling for multiple potential confounders.
Two hundred thirty-four people developed incident diabetes. Over 5 years, fatty liver resolved in 828, developed in 1640, and progressed from mild to moderate/severe in 324 people. Resolution of fatty liver was not associated with a risk of incident diabetes [aOR 0.95 (95% CIs 0.46, 1.96), P = .89]. Development of new fatty liver was associated with incident diabetes [aOR 2.49 (95% CI 1.49, 4.14), P < .001]. In individuals in whom severity of fatty liver worsened over 5 years (from mild to moderate/severe), there was a marked increase in the risk of incident diabetes [aOR 6.13 (2.56, 95% CI 14.68) P < .001 (compared with the risk in people with resolution of fatty liver)].
Change in fatty liver status over time is associated with markedly variable risks of incident diabetes.
脂肪肝与 2 型糖尿病风险增加相关，但随着时间的推移脂肪肝得到解决的人群中，这种风险是否仍然存在尚不清楚。
本研究旨在评估在以下人群中，5 年后新发糖尿病的风险：1）新发脂肪肝；2）既有脂肪肝得到解决；3）5 年内脂肪肝严重程度恶化。
本研究采用回顾性研究设计，共纳入 13218 名基线时无糖尿病的韩国职业队列人群，分别在基线和 5 年后进行检查。采用标准超声标准，在基线和随访时评估脂肪肝状态，分为无、轻度或中重度/严重。在控制多种潜在混杂因素后，使用调整后的优势比（aOR）和 95%置信区间（CI）来估计随访时新发糖尿病的风险。
234 人发生了新发糖尿病。在 5 年内，828 人脂肪肝得到解决，1640 人发生新的脂肪肝，324 人脂肪肝从轻度进展至中重度/严重。脂肪肝得到解决与新发糖尿病风险无关[aOR 0.95（95%CI 0.46，1.96），P=0.89]。新发生的脂肪肝与新发糖尿病相关[aOR 2.49（95%CI 1.49，4.14），P<0.001]。在 5 年内脂肪肝严重程度恶化（从轻度进展至中重度/严重）的个体中，新发糖尿病的风险显著增加[aOR 6.13（2.56，95%CI 14.68），P<0.001（与脂肪肝得到解决的人群相比）]。
随着时间的推移，脂肪肝状态的变化与新发糖尿病的风险显著相关。
