Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Diabetes. 2022 Sep;14(9):606-619. doi: 10.1111/1753-0407.13314.
The study aimed to explore the associations of nonalcoholic fatty liver disease (NAFLD) with the remission and progression along the glycemic continuum.
This prospective cohort study was performed among the general population in 2010-2015. NAFLD was defined as ultrasound-detected hepatic steatosis with absence of excessive alcohol consumption and other hepatic diseases. Remission of type 2 diabetes referred to glycated hemoglobin <6.5% without hypoglycemic agents for ≥3 months. Prediabetes remission referred to normalization of blood glucose. Multivariable logistic analysis was applied to identify the risk of glycemic metabolic transition.
During a median follow-up of 4.3 years, participants with NAFLD had a significantly higher risk of progressing from normal glucose tolerance to diabetes (3.36 [1.60-7.07]) and lower likelihood of diabetes remission (0.48 [0.30-0.78]). Associations in participants with overweight or obesity and higher probability of hepatic fibrosis remained consistent. Results related to the effect of NAFLD on the specific glucose parameters were generally in line with the changes of glycemic status. NAFLD improvement decreased the risk of prediabetes progressing to diabetes (0.50 [0.32-0.80]) and increased the probability of prediabetes remission (2.67 [1.49-4.79]). NAFLD tended to show the most significant association with glycemic progression and decreased the likelihood in remission of prediabetes and diabetes.
Presence of NAFLD increased risk of glycemic progression and decreased likelihood of remission. NAFLD improvement mitigated glycemic deterioration, whereas NAFLD progression impeded the chance of remission. The results emphasized joint management of NAFLD and diabetes and further focused on liver-specific subgroups of diabetes to tailor early intervention.
本研究旨在探讨非酒精性脂肪性肝病（NAFLD）与血糖连续体缓解和进展的关系。
这是一项 2010-2015 年进行的人群前瞻性队列研究。NAFLD 的定义为超声检测到的肝脂肪变性，且不存在过量饮酒和其他肝病。2 型糖尿病缓解定义为糖化血红蛋白＜6.5%且无需使用降血糖药物≥3 个月。糖尿病前期缓解定义为血糖恢复正常。多变量逻辑分析用于确定血糖代谢转变的风险。
在中位随访 4.3 年后，NAFLD 患者从正常糖耐量进展为糖尿病的风险显著更高（3.36[1.60-7.07]），糖尿病缓解的可能性更低（0.48[0.30-0.78]）。超重或肥胖患者以及肝纤维化概率较高的参与者中存在一致的相关性。与 NAFLD 对特定血糖参数的影响相关的结果通常与血糖状态的变化一致。NAFLD 改善降低了糖尿病前期进展为糖尿病的风险（0.50[0.32-0.80]），增加了糖尿病前期缓解的概率（2.67[1.49-4.79]）。NAFLD 与血糖进展的关系最为显著，降低了糖尿病前期和糖尿病缓解的可能性。
存在 NAFLD 会增加血糖进展的风险，降低缓解的可能性。NAFLD 改善减轻了血糖恶化，而 NAFLD 进展则降低了缓解的机会。结果强调了 NAFLD 和糖尿病的联合管理，并进一步关注糖尿病的肝脏特异性亚组，以制定早期干预措施。
