Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.
Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China.
J Diabetes. 2024 May;16(5):e13564. doi: 10.1111/1753-0407.13564.
Nonalcoholic fatty liver disease (NAFLD) and liver cirrhosis are significant clinical concerns, especially among individuals with type 2 diabetes mellitus (T2DM). However, in China, there is a paucity of reliable evidence detailing the characteristics of NAFLD and liver cirrhosis in T2DM. Furthermore, the relationship between blood glucose levels and NAFLD prevalence remains unclear.
Data from the Shanghai Suburban Adult Cohort and Biobank were analyzed, including 6621 participants with T2DM. NAFLD was diagnosed by ultrasonography and liver cirrhosis was performed according to the health information systems. Logistic regression and restricted cubic spline analysis were used to explore the potential risk factors for NAFLD and liver cirrhosis.
The prevalence of NAFLD was 59.36%, and liver cirrhosis was 1.43% among T2DM patients. In these patients, factors like age, being female, marital status, and obesity significantly increased the risk of NAFLD. Specifically, obesity had a strong positive association with NAFLD (odds ratio [OR] = 4.70, 95% confidence interval [CI]: 4.13-5.34). The higher glycated hemoglobin (HbA1c) quartile was associated with a heightened NAFLD risk compared to the lowest quartile (all p < .001). The HbA1c-NAFLD relationship displayed a linear that mimicked an inverted L-shaped pattern. A significant positive association existed between HbA1c levels and NAFLD for HbA1c <8.00% (OR = 1.59, 95% CI: 1.44-1.75), but this was not observed for HbA1c >8.00% (OR = 1.03, 95% CI: 0.92-1.15).
Systematic screening for NAFLD is essential in T2DM patients, especially with poor glucose control and obesity in female.
非酒精性脂肪性肝病（NAFLD）和肝硬化是重大临床关注点，尤其在 2 型糖尿病（T2DM）患者中更是如此。然而，中国缺乏详细描述 T2DM 患者中 NAFLD 和肝硬化特征的可靠证据。此外，血糖水平与 NAFLD 患病率之间的关系尚不清楚。
对上海郊区成人队列和生物库中的数据进行了分析，纳入了 6621 例 T2DM 患者。NAFLD 通过超声诊断，肝硬化则根据健康信息系统进行诊断。采用 logistic 回归和限制立方样条分析来探讨 NAFLD 和肝硬化的潜在危险因素。
T2DM 患者中，NAFLD 的患病率为 59.36%，肝硬化的患病率为 1.43%。在这些患者中，年龄、女性、婚姻状况和肥胖等因素显著增加了 NAFLD 的风险。具体而言，肥胖与 NAFLD 呈强正相关（比值比[OR] = 4.70，95%置信区间[CI]：4.13-5.34）。与最低四分位数相比，糖化血红蛋白（HbA1c）较高四分位数与更高的 NAFLD 风险相关（均 < .001）。HbA1c 与 NAFLD 之间的关系呈线性，类似于倒 L 形模式。在 HbA1c<8.00%时，HbA1c 水平与 NAFLD 之间存在显著的正相关（OR = 1.59，95%CI：1.44-1.75），但在 HbA1c>8.00%时则无此关联（OR = 1.03，95%CI：0.92-1.15）。
在 T2DM 患者中，尤其是血糖控制不佳和肥胖的女性，系统筛查 NAFLD 至关重要。
