Department of Health Management Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
J Diabetes Investig. 2020 Sep;11(5):1336-1343. doi: 10.1111/jdi.13268. Epub 2020 May 17.
AIMS/INTRODUCTION: Contrary to the results of the majority of studies on diabetes, there are some conflicting results regarding the relationship between non-alcoholic fatty liver disease (NAFLD) and prediabetes. No study has investigated the relationship between isolated glycated hemoglobin (HbA1c) in the range of 5.7-6.4% (HbA1c 5.7-6.4%) and NAFLD. Our aim was to investigate the effect of different glycemic statuses on NAFLD concomitantly categorized by fasting plasma glucose, 2-h plasma glucose and HbA1c levels.
NAFLD was classified into three groups by ultrasonographic examination results: normal, mild and moderate-to-severe. Glycemic status was divided into five groups: normoglycemia, isolated HbA1c 5.7-6.4%, impaired fasting glucose without impaired glucose tolerance (IGT), IGT and newly diagnosed diabetes. For multivariable logistic regression analyses, the outcome variable was the classified three grades of fatty changes in the liver after adjusting for other potential risk covariables.
In this cross-sectional research, a total of 8,571 eligible individuals were enrolled and divided into three groups: 5,499 without fatty liver, 2,113 with mild NAFLD and 959 with moderate-to-severe NAFLD. Multivariable logistic regression analysis showed that IGT, impaired fasting glucose without IGT and isolated HbA1c 5.7-6.4% were associated with a higher risk of NAFLD in addition to newly diagnosed diabetes. Other positively predictive variables were male sex, obesity, overweight, central obesity, increased triglyceride and C-reactive protein >1 mg/L. Negatively associated factors were elevated high-density lipoprotein cholesterol levels.
Besides diabetes, the increased risks of different grades of NAFLD were found for prediabetic individuals categorized by impaired fasting glucose without IGT, IGT and isolated HbA1c 5.7-6.4%.
目的/引言：与大多数关于糖尿病的研究结果相反，关于非酒精性脂肪性肝病（NAFLD）和糖尿病前期之间的关系存在一些相互矛盾的结果。没有研究调查过糖化血红蛋白（HbA1c）在 5.7-6.4%范围内（HbA1c 5.7-6.4%）与 NAFLD 之间的关系。我们的目的是研究不同血糖状态对同时按空腹血糖、2 小时血糖和 HbA1c 水平分类的 NAFLD 的影响。
通过超声检查结果将 NAFLD 分为三组：正常、轻度和中重度。血糖状态分为五组：正常血糖、孤立的 HbA1c 5.7-6.4%、空腹血糖受损但无糖耐量受损（IGT）、IGT 和新诊断的糖尿病。对于多变量逻辑回归分析，调整其他潜在风险协变量后，分类变量为肝脏脂肪变化的三个等级。
在这项横断面研究中，共纳入 8571 名符合条件的个体，分为三组：5499 名无脂肪肝、2113 名轻度 NAFLD 和 959 名中重度 NAFLD。多变量逻辑回归分析显示，除新诊断的糖尿病外，IGT、无 IGT 的空腹血糖受损和孤立的 HbA1c 5.7-6.4%与 NAFLD 的发生风险增加相关。其他阳性预测变量为男性、肥胖、超重、中心性肥胖、甘油三酯升高和 C 反应蛋白＞1mg/L。负相关因素为高密度脂蛋白胆固醇水平升高。
除糖尿病外，还发现空腹血糖受损无 IGT、IGT 和孤立的 HbA1c 5.7-6.4%的糖尿病前期个体发生不同程度的 NAFLD 的风险增加。
