Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Hwasun, 58128, Jeollanam-do, Republic of Korea.
Department of Biological Chemistry, University of California Irvine School of Medicine, Irvine, CA, USA.
Cardiovasc Diabetol. 2024 Nov 21;23(1):422. doi: 10.1186/s12933-024-02516-4.
This study aimed to investigate the impact of hepatic steatosis on cardiometabolic outcomes in young adults with prediabetes.
A nationwide cohort study was conducted with 896,585 young adults under 40 years old without diabetes or previous history of cardiovascular disease. Hepatic steatosis was identified using a fatty liver index of ≥ 60. The outcomes of this study were incident diabetes (DM) and composite major adverse cardiovascular events (MACE), including myocardial infarction, stroke, or cardiovascular death.
During a median follow-up of 11.8 years, 27,437 (3.1%) incident DM cases and 6,584 (0.7%) MACE cases were recorded. Young adults with prediabetes had a significantly higher risk of incident DM (hazard ratio [HR]: 2.81; 95% confidence interval [CI]: 2.74-2.88; P-value: <0.001) and composite MACE risk (HR: 1.10; 95% CI: 1.03-1.17; P-value: 0.003) compared to individuals with normoglycemia, after adjusting for relevant covariates. Stratification based on hepatic steatosis showed that the combination of prediabetes and hepatic steatosis posed the highest risk for these outcomes, after adjusting for relevant covariates. For incident DM, the HRs (95% CI; P-value) were: 3.15 (3.05-3.26; <0.001) for prediabetes without hepatic steatosis, 2.89 (2.78-3.01; <0.001) for normoglycemia with hepatic steatosis, and 6.60 (6.33-6.87; <0.001) for prediabetes with hepatic steatosis. For composite MACE, the HRs (95% CI; P-value) were 1.05 (0.97-1.13; 0.235) for prediabetes without hepatic steatosis, 1.39 (1.27-1.51; <0.001) for normoglycemia with hepatic steatosis, and 1.60 (1.44-1.78; <0.001) for prediabetes with hepatic steatosis.
Prediabetes and hepatic steatosis additively increased the risk of cardiometabolic outcomes in young adults. These findings hold significance for physicians as they provide insights into assessing high-risk individuals among young adults with prediabetes.
本研究旨在探讨非酒精性脂肪性肝病（NAFLD）对合并前期糖尿病的年轻成年人心脏代谢结局的影响。
采用全国性队列研究，纳入 896585 名年龄在 40 岁以下且无糖尿病或心血管疾病既往史的成年人。采用脂肪性肝病指数（FLI）≥60 来确定肝脂肪变性。本研究的结局是新发糖尿病（DM）和主要不良心血管事件（MACE）的复合终点，包括心肌梗死、卒中和心血管死亡。
在中位随访 11.8 年后，记录到 27437 例（3.1%）新发 DM 病例和 6584 例（0.7%）MACE 病例。与血糖正常的成年人相比，合并前期糖尿病的成年人发生新发 DM（风险比[HR]：2.81；95%置信区间[CI]：2.74-2.88；P<0.001）和复合 MACE 风险（HR：1.10；95%CI：1.03-1.17；P=0.003）的风险显著更高，校正了相关协变量后。根据肝脂肪变性进行分层显示，在校正了相关协变量后，合并前期糖尿病和肝脂肪变性的患者发生这些结局的风险最高。对于新发 DM，风险比（95%CI；P 值）为：无肝脂肪变性的前期糖尿病患者为 3.15（3.05-3.26；<0.001），有肝脂肪变性的血糖正常患者为 2.89（2.78-3.01；<0.001），有肝脂肪变性的前期糖尿病患者为 6.60（6.33-6.87；<0.001）。对于复合 MACE，风险比（95%CI；P 值）为：无肝脂肪变性的前期糖尿病患者为 1.05（0.97-1.13；0.235），有肝脂肪变性的血糖正常患者为 1.39（1.27-1.51；<0.001），有肝脂肪变性的前期糖尿病患者为 1.60（1.44-1.78；<0.001）。
前期糖尿病和肝脂肪变性使年轻成年人发生心脏代谢结局的风险增加。这些发现对医生具有重要意义，因为它们为评估合并前期糖尿病的年轻成年人中的高危人群提供了深入了解。
