Clinical availability of nonalcoholic fatty liver disease as an early predictor of type 2 diabetes mellitus in korean men: 5‐year prospective cohort study

There have been several reports about the clinical association between type 2 diabetes mellitus (DM) and nonalcoholic fatty liver disease (NAFLD). However, most of the studies were about the unilateral effects of type 2 DM on NAFLD, and studies on the reverse relation are rare. Thus, this study was designed to investigate the effect of NAFLD on type 2 DM. We conducted a prospective cohort study on 25,232 Korean men without type 2 DM for 5 years. We serially checked the various metabolic factors including fasting glucose and hemoglobin A1c (HbA1c), and monitored the development of type 2 DM. The incidence rate of type 2 DM was compared according to the degree of NAFLD (normal, mild, and moderate to severe), and a Cox proportional hazards model was used to measure the hazard ratios (HRs) of NAFLD on type 2 DM. The incidence rate of type 2 DM increased according to the degree of NAFLD (normal: 7.0%, mild: 9.8%, moderate to severe: 17.8%, P < 0.001). Even after adjusting for other multiple covariates, the HRs (95% confidence interval [CI]) for type 2 DM development was higher in the mild group (1.09; 0.81‐1.48) and moderate to severe group (1.73; 1.00‐3.01) compared to the normal group, respectively (P for trend <0.001). Conclusion: The development of type 2 DM is potentially more associated with more progressive NAFLD than a normal or milder state. In addition, NAFLD was an independent risk factor for the future development of type 2 DM. These results suggest the potential availability of NAFLD as an early predictor of type 2 DM. (HEPATOLOGY 2013;57:1378–1383)

[1]  N. Curzen,et al.  Nonalcoholic fatty liver disease and vascular risk , 2012, Current opinion in cardiology.

[2]  J. Hardies,et al.  Prevalence of Prediabetes and Diabetes and Metabolic Profile of Patients With Nonalcoholic Fatty Liver Disease (NAFLD) , 2012, Diabetes Care.

[3]  M. S. Kirkman,et al.  Response to Comment on: American Diabetes Association. Standards of Medical Care in Diabetes—2011. Diabetes Care 2011;34(Suppl. 1):S11–S61 , 2011, Diabetes Care.

[4]  Sun Woo Kim,et al.  Combined Effect of Nonalcoholic Fatty Liver Disease and Impaired Fasting Glucose on the Development of Type 2 Diabetes , 2011, Diabetes Care.

[5]  V. Basevi.  Standards of Medical Care in Diabetes—2010 , 2010, Diabetes Care.

[6]  D. Lawlor,et al.  Alanine aminotransferase, γ‐glutamyltransferase (GGT) and all‐cause mortality: results from a population‐based Danish twins study alanine aminotransferase, GGT and mortality in elderly twins , 2009, Liver international : official journal of the International Association for the Study of the Liver.

[7]  S. Grundy,et al.  Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International As , 2009, Circulation.

[8]  P. Pouwels,et al.  Pancreatic Fat Content and β-Cell Function in Men With and Without Type 2 Diabetes , 2007, Diabetes Care.

[9]  柴田 道彦.  Nonalcoholic fatty liver disease is a risk factor for type 2 diabetes in middle-aged Japanese men , 2008 .

[10]  K. Pietiläinen,et al.  Liver fat in the metabolic syndrome. , 2007, The Journal of clinical endocrinology and metabolism.

[11]  Amalia Gastaldelli,et al.  Relationship between hepatic/visceral fat and hepatic insulin resistance in nondiabetic and type 2 diabetic subjects. , 2007, Gastroenterology.

[12]  Paul Zimmet,et al.  The metabolic syndrome—a new worldwide definition , 2005, The Lancet.

[13]  G. Bedogni,et al.  Prevalence of and risk factors for nonalcoholic fatty liver disease: The Dionysos nutrition and liver study , 2005, Hepatology.

[14]  E. Ferrannini,et al.  Insulin resistance in non-diabetic patients with non-alcoholic fatty liver disease: sites and mechanisms , 2005, Diabetologia.

[15]  David Millington,et al.  Hepatic expression of malonyl-CoA decarboxylase reverses muscle, liver and whole-animal insulin resistance , 2004, Nature Medicine.

[16]  R. Turner,et al.  Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man , 1985, Diabetologia.

[17]  D. Joy,et al.  Diagnosis of fatty liver disease: is biopsy necessary? , 2003, European journal of gastroenterology & hepatology.

[18]  Erick M Remer,et al.  The utility of radiological imaging in nonalcoholic fatty liver disease. , 2002, Gastroenterology.

[19]  R. Unger,et al.  Lipotoxic diseases. , 2002, Annual review of medicine.

[20]  L. Groop,et al.  Effect of physiologic hyperinsulinemia on glucose and lipid metabolism in cirrhosis. , 1991, The Journal of clinical investigation.

[21]  J. Maxwell,et al.  Ultrasound scanning in the detection of hepatic fibrosis and steatosis. , 1986, British medical journal.