Han Eugene, Han Kyung-Do, Lee Yong-Ho, Kim Kyung-Soo, Hong Sangmo, Park Jung Hwan, Park Cheol-Young
Division of Endocrinology and Metabolism, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
Cardiovasc Diabetol. 2025 Jul 15;24(1):289. doi: 10.1186/s12933-025-02824-3.
We investigated the risk of type 2 diabetes (T2DM) and related comorbidities including cardiovascular disease (CVD), and mortality, based on changes in metabolic dysfunction associated steatotic liver disease (MASLD).
We analyzed data from the Korean National Health Insurance Service for individuals aged ≥ 20 years. MASLD was defined as a fatty liver index (FLI), a prediction formula based on metabolic parameters, with a cutoff of ≥ 60. FLI measurements were compared within each individual over a 2 years period. Based on changes in FLI between two health checkups, individuals were classified into four categories; never MASLD (FLI consistently < 60), incident MASLD (FLI < 60 to ≥ 60), regressed MASLD (≥ 60 to < 60), and persistent MASLD (FLI consistently ≥ 60). The primary outcome was T2DM occurrence in the general population and myocardial infarction (MI), ischemic stroke, heart failure (HF) and mortality events in individuals with preexisting T2DM with adjustment for age, sex, smoking, alcohol drinking, and regular exercise.
In 4,397,808 individuals without T2DM, 229,475 (5.2%) developed T2DM during a median follow-up period of 7.3 years. The risk of incident T2DM was the highest in individuals with persistent MASLD compared to those who never had MASLD (HR = 5.28, 95% CI = 5.22-5.34). Individuals with incident or regressed MASLD also had increased risk of developing T2DM (HR = 3.30, 95% CI = 3.25-3.35 for incident MASLD, HR = 2.87, 95% CI = 2.82-2.92 for regressed MASLD). In a cohort of 636,520 individuals with preexisting T2DM followed for a median of 6.2 years, those with persistent MASLD had a higher risk of HF (HR = 1.28, 95% CI = 1.25 to 1.32), MI (HR = 1.15, 95% CI = 1.10 to 1.20), stroke (HR = 1.14, 95% CI = 1.09 to 1.19) and all-cause mortality (HR = 1.11, 95% CI = 1.09-1.14) compared to individuals who never had MASLD. Similarly, both incident and regressed MASLD were associated with an increased risk for HF, MI, stroke and all-cause mortality.
Persistent MASLD is associated with an increased risk of incident T2DM, and further elevates the risk of CVD, and mortality among individuals with T2DM. Even individuals with incident or regressed MASLD exhibit an increased risk of these adverse outcomes compared to those who never had MASLD.
N/A.
我们基于代谢功能障碍相关脂肪性肝病（MASLD）的变化，调查了2型糖尿病（T2DM）及相关合并症（包括心血管疾病（CVD））的风险和死亡率。
我们分析了韩国国民健康保险服务中心提供的≥20岁个体的数据。MASLD被定义为脂肪性肝病指数（FLI），这是一个基于代谢参数的预测公式，临界值为≥60。在2年时间内对每个个体的FLI测量值进行比较。根据两次健康检查之间FLI的变化，个体被分为四类；从未患MASLD（FLI始终<60）、新发MASLD（FLI从<60变为≥60）、消退型MASLD（FLI从≥60变为<60）和持续型MASLD（FLI始终≥60）。主要结局是普通人群中T2DM的发生情况，以及已患T2DM个体中的心肌梗死（MI）、缺血性中风、心力衰竭（HF）和死亡事件，并对年龄、性别、吸烟、饮酒和规律运动进行了校正。
在4397808例无T2DM的个体中，229475例（5.2%）在中位随访期7.3年期间发生了T2DM。与从未患MASLD的个体相比，持续型MASLD个体发生T2DM的风险最高（HR = 5.28，95%CI = 5.22 - 5.34）。新发或消退型MASLD个体发生T2DM的风险也增加（新发MASLD的HR = 3.30，95%CI = 3.25 - 3.35；消退型MASLD的HR = 2.87，95%CI = 2.82 - 2.92）。在636520例已患T2DM的个体队列中，中位随访6.2年，与从未患MASLD的个体相比，持续型MASLD个体发生HF（HR = 1.28，95%CI = 1.25至1.32）、MI（HR = 1.15，95%CI = 1.10至1.20）、中风（HR = 1.14，95%CI = 1.09至1.19）和全因死亡率（HR = 1.11，95%CI = 1.09 - 1.14）的风险更高。同样，新发和消退型MASLD均与HF、MI、中风和全因死亡率风险增加相关。
持续型MASLD与新发T2DM风险增加相关，并进一步提高了T2DM个体发生CVD和死亡的风险。与从未患MASLD的个体相比，即使是新发或消退型MASLD个体出现这些不良结局的风险也有所增加。
无。
