Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Nutr Metab Cardiovasc Dis. 2019 May;29(5):489-495. doi: 10.1016/j.numecd.2019.01.016. Epub 2019 Feb 7.
It is not known whether non alcoholic fatty liver disease (NAFLD) is a risk factor for diabetes in non obese, non centrally-obese subjects. Our aim was to investigate relationships between fatty liver, insulin resistance and a biomarker score for liver fibrosis with incident diabetes at follow up, in subjects who were neither obese nor centrally-obese.
As many as 70,303 subjects with a body mass index (BMI) < 25 kg/m and without diabetes were followed up for a maximum of 7.9 years. At baseline, fatty liver was identified by liver ultrasound, insulin resistance (IR) by homeostatic model assessment of insulin resistance (HOMA-IR) ≥2.0, and central obesity by waist circumference (waist circumference ≥90 cm (men) and ≥85 cm (women). The Fibrosis-4 (FIB-4 score) was used to estimate extent of liver fibrosis. Cox proportional hazards models adjusted for confounders were used to estimate hazard ratios (aHRs) for incident diabetes. As many as 852 incident cases of diabetes occurred during follow up (median [IQR] 3.71 [2.03] years). Mean ± SD BMI was 22.8 ± 1.8 and 21.7 ± 2.0 kg/m in subjects with and without diabetes at follow up. In subjects without central obesity and with fatty liver, aHRs (95% CI) for incident diabetes at follow up were 2.17 (1.56, 3.03) for men, and 2.86 (1.50,5.46) for women. Similar aHRs for incident diabetes occurred with fatty liver, IR and the highest quartile of FIB-4 combined, in men; and there was a non significant trend toward increased risk in women.
In normal weight, non-centrally obese subjects NAFLD is an independent risk factor for incident diabetes.
非肥胖、非中心性肥胖人群的非酒精性脂肪肝（NAFLD）是否是糖尿病的危险因素尚不清楚。我们的目的是在非肥胖、非中心性肥胖人群中，调查脂肪肝、胰岛素抵抗和肝纤维化生物标志物评分与随访时新发糖尿病之间的关系。
多达 70303 名体重指数（BMI）<25kg/m2且无糖尿病的患者接受了最长 7.9 年的随访。在基线时，通过肝脏超声确定脂肪肝，通过稳态模型评估的胰岛素抵抗（HOMA-IR）≥2.0 确定胰岛素抵抗，通过腰围（男性腰围≥90cm，女性腰围≥85cm）确定中心性肥胖。使用纤维化-4（FIB-4 评分）来估计肝纤维化的程度。使用调整混杂因素的 Cox 比例风险模型来估计新发糖尿病的风险比（aHR）。在随访期间发生了 852 例新发糖尿病（中位数[IQR]3.71[2.03]年）。在随访时患有和不患有糖尿病的患者中，平均 BMI（±SD）分别为 22.8±1.8kg/m2和 21.7±2.0kg/m2。在无中心性肥胖且有脂肪肝的患者中，男性新发糖尿病的 aHR（95%CI）为 2.17（1.56，3.03），女性为 2.86（1.50，5.46）。在男性中，与脂肪肝、胰岛素抵抗和 FIB-4 最高四分位数相结合的新发糖尿病具有相似的 aHR，女性的风险呈上升趋势，但无统计学意义。
在正常体重、非中心性肥胖人群中，NAFLD 是新发糖尿病的独立危险因素。
