瘦型非酒精性脂肪性肝病与中国西北地区健康人群 2 型糖尿病发病风险的关联：一项 2 年随访期的回顾性队列研究。
Association between the lean nonalcoholic fatty liver disease and risk of incident type 2 diabetes in a healthy population of Northwest China: a retrospective cohort study with a 2-year follow-up period.
机构信息
Department of Endocrinology and Metabolism, the Hospital of Integrated Traditional Chinese Medicine and Western Medicine of Karamay, Xinjiang, China.
Department of Health Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
出版信息
Front Endocrinol (Lausanne). 2023 Jun 26;14:1173757. doi: 10.3389/fendo.2023.1173757. eCollection 2023.
AIMS
We aimed to explore the metabolic features of lean nonalcoholic fatty liver disease (Lean-NAFLD) and its association with the risk of incident type 2 diabetes in young and middle-aged people.
METHODS
We conducted a retrospective cohort study of 3001 participants who were enrolled in a health check-up program from January 2018 to December 2020 in the Health Management Center of Karamay People's Hospital. The age, sex, height, weight, body mass index (BMI), blood pressure, waist circumference (WC), fasting plasma glucose (FPG), lipid profiles, serum uric acid and alanine aminotransferase (ALT) of the subjects were collected. The cutoff point of BMI for lean nonalcoholic fatty liver disease is <25 kg/m. A COX proportional hazard regression model was used to analyze the risk ratio of lean nonalcoholic fatty liver disease to type 2 diabetes mellitus.
RESULTS
Lean NAFLD participants had many metabolic abnormalities, such as overweight and obesity with nonalcoholic fatty liver disease. Compared with lean participants without nonalcoholic fatty liver disease, the fully adjusted hazard ratio (HR) for lean participants with nonalcoholic fatty liver disease was 3.83 (95% CI 2.02-7.24, p<0.01). In the normal waist circumference group (man<90cm, woman<80 cm), compared with lean participants without NAFLD, the adjusted hazard ratios (HRs) of incident type 2 diabetes for lean participants with NAFLD and overweight or obese participants with NAFLD were 1.93 (95% CI 0.70-5.35, p>0.05) and 4.20 (95% CI 1.44-12.22, p<0.05), respectively. For excess waist circumference (man≥90 cm, woman ≥80 cm) compared with lean participants without NAFLD, the adjusted hazard ratios (HRs) of incident type 2 diabetes for lean participants with NAFLD and overweight or obese participants with NAFLD were 3.88 (95% CI 1.56-9.66, p<0.05) and 3.30 (95% CI 1.52-7.14, p<0.05), respectively.
CONCLUSION
Abdominal obesity is the strongest risk factor for type 2 diabetes in lean nonalcoholic fatty liver disease.
目的
本研究旨在探讨瘦型非酒精性脂肪性肝病（Lean-NAFLD）的代谢特征及其与中青年人群 2 型糖尿病发病风险的关系。
方法
本研究采用回顾性队列研究，纳入 2018 年 1 月至 2020 年 12 月在克拉玛依人民医院健康管理中心参加健康体检的 3001 名参与者。收集参与者的年龄、性别、身高、体重、体重指数（BMI）、血压、腰围（WC）、空腹血糖（FPG）、血脂谱、血尿酸和丙氨酸氨基转移酶（ALT）。瘦型非酒精性脂肪性肝病的 BMI 截断点为<25kg/m。采用 COX 比例风险回归模型分析瘦型非酒精性脂肪性肝病对 2 型糖尿病的风险比。
结果
Lean NAFLD 患者存在多种代谢异常，如超重和肥胖合并非酒精性脂肪性肝病。与无非酒精性脂肪性肝病的瘦型参与者相比，非酒精性脂肪性肝病的瘦型参与者的全调整危险比（HR）为 3.83（95%CI 2.02-7.24，p<0.01）。在正常腰围组（男性<90cm，女性<80cm），与无 NAFLD 的瘦型参与者相比，NAFLD 及超重或肥胖合并 NAFLD 的瘦型参与者发生 2 型糖尿病的调整后危险比（HR）分别为 1.93（95%CI 0.70-5.35，p>0.05）和 4.20（95%CI 1.44-12.22，p<0.05）。对于腰围超标组（男性≥90cm，女性≥80cm），与无 NAFLD 的瘦型参与者相比，NAFLD 及超重或肥胖合并 NAFLD 的瘦型参与者发生 2 型糖尿病的调整后危险比（HR）分别为 3.88（95%CI 1.56-9.66，p<0.05）和 3.30（95%CI 1.52-7.14，p<0.05）。
结论
腹部肥胖是非酒精性脂肪性肝病患者发生 2 型糖尿病的最强危险因素。
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