Mantovani Alessandro, Petracca Graziana, Beatrice Giorgia, Tilg Herbert, Byrne Christopher D, Targher Giovanni
Endocrinology and Metabolism, University of Verona Department of Medicine, Verona, Italy.
Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, University of Innsbruck, Innsbruck, Austria.
Gut. 2021 May;70(5):962-969. doi: 10.1136/gutjnl-2020-322572. Epub 2020 Sep 16.
Follow-up studies have shown that non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of incident diabetes, but currently, it is uncertain whether this risk changes with increasing severity of NAFLD. We performed a meta-analysis of relevant studies to quantify the magnitude of the association between NAFLD and risk of incident diabetes.
We systematically searched PubMed, Scopus and Web of Science databases from January 2000 to June 2020 using predefined keywords to identify observational studies with a follow-up duration of at least 1 year, in which NAFLD was diagnosed by imaging techniques or biopsy. Meta-analysis was performed using random-effects modelling.
33 studies with 501 022 individuals (30.8% with NAFLD) and 27 953 cases of incident diabetes over a median of 5 years (IQR: 4.0-19 years) were included. Patients with NAFLD had a higher risk of incident diabetes than those without NAFLD (n=26 studies; random-effects HR 2.19, 95% CI 1.93 to 2.48; =91.2%). Patients with more 'severe' NAFLD were also more likely to develop incident diabetes (n=9 studies; random-effects HR 2.69, 95% CI 2.08 to 3.49; =69%). This risk markedly increased across the severity of liver fibrosis (n=5 studies; random-effects HR 3.42, 95% CI 2.29 to 5.11; =44.6%). All risks were independent of age, sex, adiposity measures and other common metabolic risk factors. Sensitivity analyses did not alter these findings. Funnel plots did not reveal any significant publication bias.
This updated meta-analysis shows that NAFLD is associated with a ~2.2-fold increased risk of incident diabetes. This risk parallels the underlying severity of NAFLD.
随访研究表明，非酒精性脂肪性肝病（NAFLD）与新发糖尿病风险增加相关，但目前尚不确定该风险是否会随着NAFLD严重程度的增加而改变。我们对相关研究进行了荟萃分析，以量化NAFLD与新发糖尿病风险之间关联的程度。
我们使用预定义关键词，系统检索了2000年1月至2020年6月期间的PubMed、Scopus和Web of Science数据库，以识别随访时间至少为1年的观察性研究，其中NAFLD通过影像学技术或活检诊断。采用随机效应模型进行荟萃分析。
纳入了33项研究，共501022名个体（30.8%患有NAFLD），在中位5年（四分位间距：4.0 - 19年）期间有27953例新发糖尿病病例。患有NAFLD的患者比未患NAFLD的患者发生新发糖尿病的风险更高（n = 26项研究；随机效应风险比2.19，95%置信区间1.93至2.48；P = 91.2%）。“更严重”的NAFLD患者也更有可能发生新发糖尿病（n = 9项研究；随机效应风险比2.69，95%置信区间2.08至3.49；P = 69%）。这种风险在肝纤维化严重程度中显著增加（n = 5项研究；随机效应风险比3.42，95%置信区间2.29至5.11；P = 44.6%）。所有风险均独立于年龄、性别、肥胖指标和其他常见代谢风险因素。敏感性分析未改变这些结果。漏斗图未显示任何显著的发表偏倚。
这项更新的荟萃分析表明，NAFLD与新发糖尿病风险增加约2.2倍相关。这种风险与NAFLD的潜在严重程度平行。
