Jäger Susanne, Jacobs Simone, Kröger Janine, Stefan Norbert, Fritsche Andreas, Weikert Cornelia, Boeing Heiner, Schulze Matthias B
Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany.
German Center for Diabetes Research (DZD), Neuherberg, Germany; Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, University Hospital Tübingen, Tübingen, Germany.
PLoS One. 2015 Apr 22;10(4):e0124749. doi: 10.1371/journal.pone.0124749. eCollection 2015.
The fatty liver index (FLI) predicts fatty liver by using BMI, waist circumference, γ-glutamyltransferase and triglycerides. We investigated the association between the FLI and the risk of type 2 diabetes and evaluated to what extent single FLI components contribute to the diabetes risk. We analysed a case-cohort study (random sub-cohort: 1922; incident cases: 563) nested within the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study. The proportion of exposure effect (PEE) explained by single FLI components was evaluated and effect decomposition using inverse probability weighting (IPW) was applied. Women and men with a FLI ≥ 60 compared to those with a FLI < 30 had a multivariable-adjusted Hazard Ratio (HR) of 17.6; 95% confidence interval (CI) 11.1-28.0 and HR: 10.9; 95% CI 6.22-19.2, respectively. Adjustment for BMI or waist circumference attenuated this association in men [PEE BMI (95% CI) = 53.8% (43.9%-65.8%); PEE waist (95% CI) = 54.8% (44.2%-68.8%)]. In women, adjustment for waist circumference attenuated the association to a lesser degree than in men [PEE waist (95% CI) = 31.1%; (21.9%-43.1%)] while BMI had no appreciable effect [PEE BMI (95% CI) = 11.0% (2.68%-21.0%)]. γ-glutamyltransferase and triglycerides showed only a small attenuation in women [PEE GGT(95% CI) = 3.11% (-0.72%-4.48%); PEE TG (95% CI) = 6.36% (3.81%-9.92%)] and in men [PEE GGT = 0%; PEE TG (95% CI) = 6.23% (2.03%-11.8%)]. In women, the total effect was decomposed into a direct effect and 4 indirect effects (HR BMI = 1.10; HR waist = 1.28; HR GGT = 0.97 and HR TG = 1.03). In men, the 4 indirect effects were HR BMI = 1.25; HR waist = 1.29; HR GGT = 0.97 and HR TG = 0.99. These data suggest that the FLI, as a proxy for fatty liver, is associated with risk of type 2 diabetes. This association is only partly explained by standard estimates of overall and abdominal body fatness, particularly among women.
脂肪肝指数（FLI）通过使用体重指数（BMI）、腰围、γ-谷氨酰转移酶和甘油三酯来预测脂肪肝。我们研究了FLI与2型糖尿病风险之间的关联，并评估了单个FLI成分在多大程度上导致糖尿病风险。我们分析了嵌套在欧洲癌症与营养前瞻性调查（EPIC）-波茨坦研究中的一项病例队列研究（随机子队列：1922例；新发病例：563例）。评估了单个FLI成分所解释的暴露效应比例（PEE），并应用逆概率加权（IPW）进行效应分解。与FLI<30的女性和男性相比，FLI≥60的女性和男性的多变量调整风险比（HR）分别为17.6；95%置信区间（CI）为11.1-28.0和HR：10.9；95%CI为6.22-19.2。对BMI或腰围进行调整后，男性的这种关联减弱[PEE BMI（95%CI）=53.8%（43.9%-65.8%）；PEE腰围（95%CI）=54.8%（44.2%-68.8%）]。在女性中，对腰围进行调整后，这种关联的减弱程度低于男性[PEE腰围（95%CI）=31.1%；（21.9%-43.1%）]，而BMI没有明显影响[PEE BMI（95%CI）=11.0%（2.68%-21.0%）]。γ-谷氨酰转移酶和甘油三酯在女性[PEE GGT（95%CI）=3.11%（-0.72%-）]。在女性中，总效应被分解为直接效应和4种间接效应（HR BMI = 1.10；HR腰围 = 1.28；HR GGT = 0.97；HR甘油三酯 = 1.03）。在男性中，4种间接效应为HR BMI = 1.25；HR腰围 = 1.29；HR GGT = 0.97；HR甘油三酯 = 0.99。这些数据表明，作为脂肪肝替代指标的FLI与2型糖尿病风险相关。这种关联仅部分由总体和腹部肥胖的标准估计值解释，尤其是在女性中。 4.48%）和男性[PEE GGT = 0%；PEE甘油三酯（95%CI）=6.23%（2.03%-11.8%）]中仅显示出较小的减弱。
