Abstract
BackgroundWe aimed to determine the association between nonalcoholic fatty liver disease (NAFLD) and diabetes risk among body size phenotypes which was based on cross-classification of body mass index (BMI) categories (normal or overweight/obesity) and metabolic status (metabolically health or metabolically at-risk).MethodsWe conducted a cross-sectional analysis using a cohort of 10,761 apparently healthy Chinese adults who underwent comprehensive health checkups including abdominal ultrasonography. Subjects were classified as metabolically at-risk by having any two of the following, consistent with the Adult Treatment Panel-III metabolic syndrome definition: (1) systolic/diastolic blood pressure ≥130/85 mmHg, (2) triglycerides ≥1.7 mmol/L, (3) fasting blood glucose ≥5.6 mmol/L, (4) HDL-cholesterol ≥1.0/1.3 mmol/L for men/women.ResultsAmong participants without metabolically at-risk, multivariate-adjusted odds ratios (ORs) for diabetes from NAFLD compared with those without NAFLD in the normal-weight (BMI <23 kg/m2) and overweight/obese (BMI ≥23 kg/m2) group were 2.10 (1.85–3.93) and 1.85 (1.35–2.53), respectively. Among participants with metabolically at-risk, the significant association between NAFLD and diabetes was lost, regardless of obesity status. There were only 27.1 % subjects with the presence of the three factors (overweight/obesity, NAFLD, and metabolically at-risk) occurring together, while the three factors occurring together was common (56.16 %) in diabetic individuals. The multivariate-adjusted ORs for diabetes were 1.1 (0.61–1.98) for overweight/obesity, 2.23 (1.05–5.14) for NAFLD, and 8.04 (5.0–12.09) for metabolically at-risk. The OR for the presence of all the three factors occurring together was 23.22 (13.96–38.63).ConclusionsNAFLD was associated with diabetes risk among participants without metabolically at-risk. The clustering of overweight/obesity, NAFLD, and metabolically at-risk is common in diabetic subjects and strikingly and markedly increases the diabetes risk.
Highlights
We aimed to determine the association between nonalcoholic fatty liver disease (NAFLD) and diabetes risk among body size phenotypes which was based on cross-classification of body mass index (BMI) categories and metabolic status
In each body size phenotype, subjects with NAFLD showed more atherogenic lipid profile as indicated by higher levels of TG, low-density lipoprotein cholesterol (LDL-C), TG/high-density lipoprotein cholesterol (HDL-C), and lower levels of HDL-C, and higher fasting blood glucose (FBG) levels than subjects without NAFLD; Concentrations of atherogenic lipids and FBG were significantly higher in the metabolically healthy and normal weight (MHNW)/with NAFLD group compared with the MHO/without NAFLD group, implying that the associations of NAFLD with unfavorable lipid and glucose profiles were stronger than those of overweight/obesity
For a given BMI status, the most favorable lipid profile and glucose levels were found in individuals with metabolically health/without NAFLD, and the worst atherogenic lipid profile and glucose levels were found in individuals with metabolically at-risk/with NAFLD: indicating that NAFLD and metabolically at-risk have synergistic effects on atherogenic lipid and glucose concentrations
Summary
We aimed to determine the association between nonalcoholic fatty liver disease (NAFLD) and diabetes risk among body size phenotypes which was based on cross-classification of body mass index (BMI) categories (normal or overweight/obesity) and metabolic status (metabolically health or metabolically at-risk). Evidence shows that NAFLD is only associated with increased arterial stiffness [11] or carotid intima-media thickness [12] in the presence of metabolic risk factors. Data demonstrate that NAFLD forecasts an increased risk of cardiovascular disease (CVD) [13] independent of metabolic syndrome. Body mass index (BMI) is a poor indicator of body fat distribution, as evidenced by the occurrence of the variation in the burden of metabolic disorders, diabetes, and CVD among individuals with similar BMI [14]. Few studies have examined CVD risk factors and diabetes risk associated with NAFLD among body size phenotypes
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