The effect of diabetes and prediabetes on the prevalence, complications and mortality in nonalcoholic fatty liver disease
2
조회
0
다운로드
4
인용
0
참고문헌
키워드
초록
Background/Aims: Nonalcoholic fatty liver disease (NAFLD) is closely associated with diabetes. The cumulative impact of both diseases synergistically increases risk of adverse events. However, present population analysis is predominantly conducted with reference to non-NAFLD individuals and has not yet examined the impact of prediabetes. Hence, we sought to conduct a retrospective analysis on the impact of diabetic status in NAFLD patients, referencing non-diabetic NAFLD individuals. Methods: Data from the National Health and Nutrition Examination Survey 1999–2018 was used. Hepatic steatosis was defined with United States Fatty Liver Index (US-FLI) and FLI at a cut-off of 30 and 60 respectively, in absence of substantial alcohol use. A multivariate generalized linear model was used for risk ratios of binary outcomes while survival analysis was conducted with Cox regression and Fine Gray model for competing risk. Results: Of 32,234 patients, 28.92% were identified to have NAFLD. 36.04%, 38.32% and 25.63% were non-diabetic, prediabetic and diabetic respectively. Diabetic NAFLD significantly increased risk of cardiovascular disease (CVD), stroke, chronic kidney disease, all-cause and CVD mortality compared to non-diabetic NAFLD. However, prediabetic NAFLD only significantly increased the risk of CVD and did not result in a higher risk of mortality. Conclusions: Given the increased risk of adverse outcomes, this study highlights the importance of regular diabetes screening in NAFLD and adoption of prompt lifestyle modifications to reduce disease progression. Facing high cardiovascular burden, prediabetic and diabetic NAFLD individuals can benefit from early cardiovascular referrals to reduce risk of CVD events and mortality.
Abstract
Background/Aims: Nonalcoholic fatty liver disease (NAFLD) is closely associated with diabetes. The cumulative impact of both diseases synergistically increases risk of adverse events. However, present population analysis is predominantly conducted with reference to non-NAFLD individuals and has not yet examined the impact of prediabetes. Hence, we sought to conduct a retrospective analysis on the impact of diabetic status in NAFLD patients, referencing non-diabetic NAFLD individuals. Methods: Data from the National Health and Nutrition Examination Survey 1999–2018 was used. Hepatic steatosis was defined with United States Fatty Liver Index (US-FLI) and FLI at a cut-off of 30 and 60 respectively, in absence of substantial alcohol use. A multivariate generalized linear model was used for risk ratios of binary outcomes while survival analysis was conducted with Cox regression and Fine Gray model for competing risk. Results: Of 32,234 patients, 28.92% were identified to have NAFLD. 36.04%, 38.32% and 25.63% were non-diabetic, prediabetic and diabetic respectively. Diabetic NAFLD significantly increased risk of cardiovascular disease (CVD), stroke, chronic kidney disease, all-cause and CVD mortality compared to non-diabetic NAFLD. However, prediabetic NAFLD only significantly increased the risk of CVD and did not result in a higher risk of mortality. Conclusions: Given the increased risk of adverse outcomes, this study highlights the importance of regular diabetes screening in NAFLD and adoption of prompt lifestyle modifications to reduce disease progression. Facing high cardiovascular burden, prediabetic and diabetic NAFLD individuals can benefit from early cardiovascular referrals to reduce risk of CVD events and mortality.
참고문헌 (37)
- Sanyal AJ, "Past, present and future perspectives in nonalcoholic fatty liver disease", Nat Rev Gastroenterol Hepatol, 16, pp.377~386 (2019)
- Grace En Hui Lim, "An Observational Data Meta-analysis on the Differences in Prevalence and Risk Factors Between MAFLD vs NAFLD", Clinical Gastroenterology and Hepatology, 21(3), pp.619~629.e7 (2021), Elsevier BV[DOI]
- Michael H. Le, "2019 Global NAFLD Prevalence: A Systematic Review and Meta-analysis", Clinical Gastroenterology and Hepatology, 20(12), pp.2809~2817.e28 (2022), Elsevier BV[DOI]
- Muthiah MD, "A clinical overview of non-alcoholic fatty liver disease : a guide to diagnosis, the clinical features, and complications-what the non-specialist needs to know", Diabetes Obes Metab, 24(2), pp.3~14 (2022)
- Ansel Shao Pin Tang, "Non-alcoholic fatty liver disease increases risk of carotid atherosclerosis and ischemic stroke: An updated meta-analysis with 135,602 individuals", Clinical and Molecular Hepatology, 28(3), pp.483~496 (2022), 대한간학회[DOI]
- Jonathan Zhi Kai Toh, "A Meta-Analysis on the Global Prevalence, Risk factors and Screening of Coronary Heart Disease in Nonalcoholic Fatty Liver Disease", Clinical Gastroenterology and Hepatology, 20(11), pp.2462~2473.e10 (2022), Elsevier BV[DOI]
- Tan DJH, "Clinical characteristics, surveillance, treatment allocation, and outcomes of non-alcoholic fatty liver disease-related hepatocellular carcinoma : a systematic review and meta-analysis", Lancet Oncol, 23, pp.521~530 (2022)
- Xiao J, "Is fatty liver associated with depression? A meta-analysis and systematic review on the prevalence, risk factors, and outcomes of depression and non-alcoholic fatty liver disease", Front Med(Lausanne), 8, pp.691696~ (2021)
- Targher G, "The complex link between NAFLD and type 2 diabetes mellitus-mechanisms and treatments", Nat Rev Gastroenterol Hepatol, 18, pp.599~612 (2021)
- Younossi ZM, "The global epidemiology of NAFLD and NASH in patients with type 2 diabetes : a systematic review and meta-analysis", J Hepatol, 71, pp.793~801 (2019)
- Mantovani A, "Non-alcoholic fatty liver disease and risk of incident diabetes mellitus : an updated meta-analysis of 501 022 adult individuals", Gut, 70, pp.962~969 (2021)
- American Diabetes Association, "4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes—2019", Diabetes Care, 42(1), pp.S34~S45 (2018), American Diabetes Association[DOI]
- Mallet V, "Burden of liver disease progression in hospitalized patients with type 2 diabetes mellitus", J Hepatol, 76, pp.265~274 (2022)
- Wild SH, "Cardiovascular disease, cancer, and mortality among people with type 2 diabetes and alcoholic or nonalcoholic fatty liver disease hospital admission", Diabetes Care, 41, pp.341~347 (2018)
- Taharboucht S, "Pre-diabetes and NAFLD; a study of an Algerian population sample", Endocrine and Metabolic Science, 1, pp.100060~ (2020)
- Vesa CM, "Prediction of NAFLD occurrence in prediabetes patients", Exp Ther Med, 20, pp.190~ (2020)
- Rajput R, "Prevalence and predictors of non-alcoholic fatty liver disease in prediabetes", Diabetes Metab Syndr, 13, pp.2957~2960 (2019)
- Ruhl CE, "Fatty liver indices in the multiethnic United States National Health and Nutrition Examination Survey", Aliment Pharmacol Ther, 41, pp.65~76 (2015)
- Bedogni G, "The fatty liver index : a simple and accurate predictor of hepatic steatosis in the general population", BMC Gastroenterol, 6, pp.33~ (2006)
- undefined, "Standards of Medical Care in Diabetes—2015: Summary of Revisions", Diabetes Care, 38(Supplement_1), pp.S4~S4 (2014), American Diabetes Association[DOI]
- Wong VW, "Noninvasive biomarkers in NAFLD and NASH-current progress and future promise", Nat Rev Gastroenterol Hepatol, 15, pp.461~478 (2018)
- WHO Expert Consultation, "Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies", Lancet, 363, pp.157~163 (2004)
- Levey AS, "Chronic kidney disease", Lancet, 379, pp.165~180 (2012)
- Cummings P, "Methods for estimating adjusted risk ratios", Stata J, 9, pp.175~196 (2009)
- Peter Cummings, "The Relative Merits of Risk Ratios and Odds Ratios", Archives of Pediatrics & Adolescent Medicine, 163(5), pp.438~ (2009), American Medical Association (AMA)[DOI]
- Wu W, "Association between diabetes mellitus and all-cause and cardiovascular mortality among individuals with ultrasound-defined non-alcoholic fatty liver disease", Front Endocrinol(Lausanne), 12, pp.773342~ (2021)
- Hostalek U, "Global epidemiology of prediabetes-present and future perspectives", Clin Diabetes Endocrinol, 5, pp.5~ (2019)
- Tabák AG, "Prediabetes : a high-risk state for diabetes development", Lancet, 379, pp.2279~2290 (2012)
- Bansal N, "Prediabetes diagnosis and treatment : a review", World J Diabetes, 6, pp.296~303 (2015)
- Przybyszewski EM, "Nonalcoholic fatty liver disease and cardiovascular disease", Clin Liver Dis(Hoboken), 17, pp.19~22 (2021)
- Mantovani A, "Non-alcoholic fatty liver disease and risk of fatal and non-fatal cardiovascular events : an updated systematic review and meta-analysis", Lancet Gastroenterol Hepatol, 6, pp.903~913 (2021)
- Almourani R, "Diabetes and cardiovascular disease : an update", Curr Diab Rep, 19, pp.161~ (2019)
- Yang JJ, "Association of diabetes with all-cause and cause-specific mortality in Asia : a pooled analysis of more than 1 million participants", JAMA Netw Open, 2, pp.e192696~ (2019)
- Chalasani N, "The diagnosis and management of nonalcoholic fatty liver disease : practice guidance from the American Association for the Study of Liver Diseases", Hepatology, 67, pp.328~357 (2018)
- Mantovani A, "Glucagon-like peptide-1 receptor agonists for treatment of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis : an updated meta-analysis of randomized controlled trials", Metabolites, 11, pp.73~ (2021)
- Wong C, "Sodium-glucose co-transporter 2 inhibitors for non-alcoholic fatty liver disease in asian patients with type 2 diabetes: a metaanalysis", Front Endocrinol (Lausanne), 11, pp.609135~ (2021)
- Ng CH, "Antidiabetic medications for type 2 diabetics with nonalcoholic fatty liver disease : evidence from a network meta-analysis of randomized controlled trials", Endocr Pract, 28, pp.223~230 (2022)