Diabetes Research Institute, Division of Endocrinology, Diabetes and Metabolism, University of Miami Miller School of Medicine, Miami, FL 33136USA.
Milken Institute School of Public Health and Health Services, The Biostatistics Center, George Washington University, Rockville, MD 20852USA.
J Clin Endocrinol Metab. 2021 Oct 21;106(11):e4746-e4765. doi: 10.1210/clinem/dgab160.
There is little information about fatty liver in prediabetes as it transitions to early diabetes.
This study is aimed at evaluating the prevalence and determinants of fatty liver in the Diabetes Prevention Program (DPP).
We measured liver fat as liver attenuation (LA) in Hounsfield units (HU) in 1876 participants at ~14 years following randomization into the DPP, which tested the effects of lifestyle or metformin interventions versus standard care to prevent diabetes. LA was compared among intervention groups and in those with versus without diabetes, and associations with baseline and follow-up measurements of anthropometric and metabolic covariates were assessed.
There were no differences in liver fat between treatment groups at 14 years of follow-up. Participants with diabetes had lower LA (mean ± SD: 46 ± 16 vs 51 ± 14 HU; P < 0.001) and a greater prevalence of fatty liver (LA < 40 HU) (34% vs 17%; P < 0.001). Severity of metabolic abnormalities at the time of LA evaluation was associated with lower LA categories in a graded manner and more strongly in those with diabetes. Averaged annual fasting insulin (an index of insulin resistance [OR, 95% CI 1.76, 1.41-2.20]) waist circumference (1.63, 1.17-2.26), and triglyceride (1.42, 1.13-1.78), but not glucose, were independently associated with LA < 40 HU prevalence.
Fatty liver is common in the early phases of diabetes development. The association of LA with insulin resistance, waist circumference, and triglyceride levels emphasizes the importance of these markers for hepatic steatosis in this population and that assessment of hepatic fat in early diabetes development is warranted.
在糖尿病前期向早期糖尿病过渡期间，有关脂肪肝的信息很少。
本研究旨在评估糖尿病预防计划（DPP）中脂肪肝的患病率和决定因素。
我们在随机分配到 DPP 后的大约 14 年时，用 Hounsfield 单位（HU）测量了 1876 名参与者的肝脂肪量，即肝衰减（LA）。DPP 旨在测试生活方式或二甲双胍干预与标准护理预防糖尿病的效果。我们比较了干预组之间以及有糖尿病和无糖尿病患者之间的 LA，并评估了基线和随访时人体测量和代谢协变量的测量值与 LA 的相关性。
在 14 年的随访中，治疗组之间的肝脂肪量没有差异。有糖尿病的患者 LA 较低（平均值 ± 标准差：46 ± 16 比 51 ± 14 HU；P < 0.001），脂肪肝的患病率更高（LA < 40 HU）（34%比 17%；P < 0.001）。LA 评估时代谢异常的严重程度与 LA 类别呈梯度相关，在有糖尿病的患者中更为明显。平均每年空腹胰岛素（胰岛素抵抗的指标[比值比，95%可信区间 1.76，1.41-2.20]）、腰围（1.63，1.17-2.26）和甘油三酯（1.42，1.13-1.78），但不是血糖，与 LA < 40 HU 的患病率独立相关。
脂肪肝在糖尿病发展的早期阶段很常见。LA 与胰岛素抵抗、腰围和甘油三酯水平相关，这强调了这些标志物在该人群中对肝脂肪变性的重要性，并且在早期糖尿病发展中评估肝脂肪含量是合理的。
