Wang Minzhen, Zhao Yanan, He Yingqian, Zhang Lulu, Liu Jing, Zheng Shan, Bai Yana
Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, Gansu, China.
Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, Gansu, China.
Nutr Metab Cardiovasc Dis. 2023 Aug;33(8):1521-1528. doi: 10.1016/j.numecd.2023.05.018. Epub 2023 May 17.
To explore the bidirectional relationship between NAFLD and type 2 diabetes and the possible directions of the main effect.
30 633 participants from the Jinchang cohort were enrolled. Firstly, cox proportional hazards regression model was used to assess the unidirectional causality between NAFLD and prediabetes and type 2 diabetes. Secondly, cross-lag path analysis model was conducted to estimate the bidirectional relationship between NAFLD and prediabetes and type 2 diabetes, and to determine the direction of the main effects. Finally, potential effect modifications were also considered by age, sex, hyperlipidemia, and overweight/obesity. We found that NAFLD increased the risk of prediabetes and type 2 diabetes with adjusted HR (95%CI) of 1.355(95%CI: 1.255-1.462) and 1.898(95%CI: 1.415-2.545), respectively. Prediabetes and type 2 diabetes also increased the risk of NAFLD, with adjusted HR (95%CI) of 1.245(95%CI: 1.115-1.392) and 1.592(95%CI: 1.373-1.846), respectively. Cross-lag path analysis showed that NAFLD significantly affected the incidence of prediabetes (β = 0.285, P < 0.001), while the effect on type 2 diabetes was not statistically significant. The effect of prediabetes and type 2 diabetes on the risk of NAFLD was weak, and the path coefficients were 0.076 and 0.037, respectively. Stratified analyses showed similar results.
This study provides evidence that there was a bidirectional causal association between NAFLD and type 2 diabetes, and the progression from NAFLD through prediabetes to type 2 diabetes may be the main pathway.
探讨非酒精性脂肪性肝病（NAFLD）与2型糖尿病之间的双向关系以及主要效应的可能方向。
纳入金昌队列的30633名参与者。首先，采用Cox比例风险回归模型评估NAFLD与糖尿病前期及2型糖尿病之间的单向因果关系。其次，进行交叉滞后路径分析模型，以估计NAFLD与糖尿病前期及2型糖尿病之间的双向关系，并确定主要效应的方向。最后，还考虑了年龄、性别、高脂血症和超重/肥胖等潜在效应修饰因素。我们发现，NAFLD增加了糖尿病前期和2型糖尿病的风险，校正后的风险比（95%置信区间）分别为1.355（95%置信区间：1.255 - 1.462）和1.898（95%置信区间：1.415 - 2.545）。糖尿病前期和2型糖尿病也增加了NAFLD的风险，校正后的风险比（95%置信区间）分别为1.245（95%置信区间：1.115 - 1.392）和1.592（95%置信区间：1.373 - 1.846）。交叉滞后路径分析表明，NAFLD显著影响糖尿病前期的发病率（β = 0.285，P < 0.001），而对2型糖尿病的影响无统计学意义。糖尿病前期和2型糖尿病对NAFLD风险的影响较弱，路径系数分别为0.076和0.037。分层分析显示了相似的结果。
本研究提供了证据表明NAFLD与2型糖尿病之间存在双向因果关联，并且从NAFLD经糖尿病前期进展至2型糖尿病可能是主要途径。
