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Title: The Effect of Diabetes and Prediabetes on the Prevalence, Complications and Mortality in Non-alcoholic Fatty Liver Disease.
Authors: Ng, Cheng Han
Chan, Kai En
Chin, Yip Han
Zeng, Rebecca Wenling
Tsai, Pei Chen
Lim, Wen Hui
Tan, Darren Jun Hao
Khoo, Chin Meng 
Goh, Lay Hoon 
Ling, Zheng Jye 
Kulkarni, Anand
Mak, Lung-Yi Loey
Huang, Daniel Q
Chan, Mark
Chew, Nicholas Ws
Siddiqui, Mohammad Shadab
Sanyal, Arun J
Muthiah, Mark
Keywords: Diabetes
Non-alcoholic steatohepatitis
Issue Date: 19-May-2022
Publisher: The Korean Association for the Study of the Liver
Citation: Ng, Cheng Han, Chan, Kai En, Chin, Yip Han, Zeng, Rebecca Wenling, Tsai, Pei Chen, Lim, Wen Hui, Tan, Darren Jun Hao, Khoo, Chin Meng, Goh, Lay Hoon, Ling, Zheng Jye, Kulkarni, Anand, Mak, Lung-Yi Loey, Huang, Daniel Q, Chan, Mark, Chew, Nicholas Ws, Siddiqui, Mohammad Shadab, Sanyal, Arun J, Muthiah, Mark (2022-05-19). The Effect of Diabetes and Prediabetes on the Prevalence, Complications and Mortality in Non-alcoholic Fatty Liver Disease.. Clin Mol Hepatol. ScholarBank@NUS Repository.
Abstract: Background & Aims: Non-alcoholic 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 (CKD), 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. Conclusion: 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.
Source Title: Clin Mol Hepatol
ISSN: 2287-2728
DOI: 10.3350/cmh.2022.0096
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