Dialysis Department of Nephrology Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China.
Nephrology Department of Eastern Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China.
Diabetes Metab. 2021 May;47(3):101200. doi: 10.1016/j.diabet.2020.08.008. Epub 2020 Oct 16.
Convincing evidence suggests that non-alcoholic fatty liver disease (NAFLD) is associated with insulin resistance and an increased risk of diabetes; however, the association between lean NAFLD and incident diabetes, and especially differences according to gender, have not been reported thus far. This study therefore aimed to investigate whether lean NAFLD and overweight/obese NAFLD confer the same excess risk of new-onset diabetes in both genders.
Our longitudinal study was performed in 14,482 euglycaemic adults who had participated in a health checkup programme. Fatty liver was diagnosed by abdominal ultrasonography. The outcome of interest was incident diabetes.
Over the median 6.0 years of follow-up, 356 cases of diabetes were diagnosed. After adjusting for sociodemographic and other potential confounders, the fully adjusted HR (95% CI) for incident diabetes in lean NAFLD vs lean without NAFLD patients was 2.58 (95% CI: 1.68-3.97) in the total cohort. Corresponding HRs were 5.53 (95% CI: 2.30-13.30) and 2.02 (95% CI: 1.24-3.31) for women and men, respectively. Post-hoc analysis revealed that the relative risk for developing diabetes was similar between lean and overweight/obese NAFLD groups whether in the entire study population or in subgroups stratified by gender (all P> 0.05).
Lean NAFLD is indeed a risk factor for incident type 2 diabetes in both genders, although the effect appeared to be more pronounced in women than in men. Further investigations are now needed to obtain a better understanding of the natural history of NAFLD in lean subjects.
大量证据表明，非酒精性脂肪性肝病（NAFLD）与胰岛素抵抗和糖尿病风险增加有关；然而，瘦型 NAFLD 与新发糖尿病之间的关联，尤其是根据性别存在的差异，目前尚未有报道。因此，本研究旨在探讨瘦型 NAFLD 和超重/肥胖型 NAFLD 是否在两性中导致新发糖尿病的风险同样增加。
我们的纵向研究纳入了 14482 名参加健康体检计划的血糖正常的成年人。通过腹部超声诊断脂肪肝。感兴趣的结局是新发糖尿病。
在中位 6.0 年的随访期间，诊断出 356 例糖尿病。在校正了社会人口统计学和其他潜在混杂因素后，在总队列中，与非 NAFLD 的瘦型患者相比，NAFLD 的瘦型患者新发糖尿病的全调整 HR（95%CI）为 2.58（95%CI：1.68-3.97）。相应的 HR 分别为女性 5.53（95%CI：2.30-13.30）和男性 2.02（95%CI：1.24-3.31）。事后分析显示，无论在整个研究人群中还是在按性别分层的亚组中，发生糖尿病的相对风险在瘦型和超重/肥胖型 NAFLD 组之间相似（所有 P>0.05）。
瘦型 NAFLD 确实是两性中发生 2 型糖尿病的一个危险因素，尽管这种效应在女性中似乎比男性更明显。现在需要进一步的研究来更好地了解瘦型人群中 NAFLD 的自然史。
