Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
The Third Central Hospital of Tianjin, Tianjin, China.
J Intern Med. 2022 Apr;291(4):469-480. doi: 10.1111/joim.13428. Epub 2021 Dec 22.
Non-alcoholic fatty liver disease (NAFLD) is a strong risk factor for type 2 diabetes. However, no study has investigated whether dietary intake can modify this effect. Therefore, we aimed to investigate the effect of dietary pattern modification on the association between NAFLD and type 2 diabetes.
A large prospective cohort study (n = 24,602) was conducted in China. NAFLD was diagnosed using liver ultrasonography considering alcohol consumption. Dietary data were assessed using a validated self-administered food frequency questionnaire. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
Following a 93,873 person-year follow-up, 787 (3.20%) participants developed type 2 diabetes. In a multivariable adjusted model, compared with participants without NAFLD, the HR (95% CI) of incident type 2 diabetes for NAFLD patients was 3.04 (2.51, 3.68). On subgroup analyses, the adjusted HRs (95% CIs) of incident type 2 diabetes for NAFLD patients with low (≤median score) and high (>median score) vegetable pattern intakes were 4.08 (3.05, 5.46) and 2.38 (1.85, 3.07) (p for interaction <0.01), respectively. Higher vegetable intake was also found to attenuate the risk effect of phenotype groups of NAFLD on incident type 2 diabetes, especially in the lean NAFLD group.
The present study demonstrated that NAFLD is a strong risk factor for type 2 diabetes in the Chinese population. Notably, adherence to a dietary pattern rich in vegetables can attenuate this risk, especially in lean NAFLD patients.
非酒精性脂肪性肝病（NAFLD）是 2 型糖尿病的一个强烈危险因素。然而，尚无研究调查饮食摄入是否可以改变这种作用。因此，我们旨在研究饮食模式改变对 NAFLD 与 2 型糖尿病之间关联的影响。
在中国进行了一项大型前瞻性队列研究（n=24602）。考虑到饮酒情况，使用肝脏超声检查来诊断 NAFLD。使用经过验证的自我管理食物频率问卷评估饮食数据。使用 Cox 比例风险回归来估计风险比（HR）和 95%置信区间（CI）。
在 93873 人年的随访后，787（3.20%）名参与者发生了 2 型糖尿病。在多变量调整模型中，与无 NAFLD 的参与者相比，NAFLD 患者发生 2 型糖尿病的 HR（95%CI）为 3.04（2.51，3.68）。在亚组分析中，NAFLD 患者低（≤中位数评分）和高（>中位数评分）蔬菜模式摄入量的 2 型糖尿病发病调整 HR（95%CI）分别为 4.08（3.05，5.46）和 2.38（1.85，3.07）（p 交互<0.01）。较高的蔬菜摄入量也发现可以减弱 NAFLD 表型组对 2 型糖尿病发病的风险作用，尤其是在瘦型 NAFLD 组中。
本研究表明，NAFLD 是中国人群 2 型糖尿病的一个强烈危险因素。值得注意的是，坚持富含蔬菜的饮食模式可以减弱这种风险，尤其是在瘦型 NAFLD 患者中。
