Abstract
Background & aimsIn patients at metabolic risk, nonalcoholic fatty liver disease is a strong and highly prevalent predictor for type 2 diabetes. Its assessment in clinical practice is not easy but the fatty liver index (FLI) could be used as a surrogate. Here, we studied the association between the FLI and the conversion to new-onset diabetes (NOD) or prediabetes reversion in patients with prediabetes.MethodsThe IT-DIAB observational study included 389 individuals with prediabetes, defined as fasting plasma glucose (FPG) between 110 and 125 mg/dL. NOD conversion was defined as a first FPG value ≥ 126 mg/dL and prediabetes reversion as a first FPG value < 110 mg/dL. The associations of both events with baseline FLI were studied separately using multivariate Cox models.ResultsAfter a median follow-up of 3.9 years (range 0.1–6.1), 138 individuals (35.5%) converted to NOD. FLI was associated with a higher risk of NOD conversion (unadjusted HR per SD = 1.54, 95%CI 1.27–1.86, p<0.0001), even after multiple adjustment on FPG, HbA1c and diabetes risk score (adjusted HR per SD 1.31, 95%CI 1.07–1.61, p = 0.008). FLI was also associated with prediabetes reversion: adjusted HR per SD = 0.85, 95%CI 0.75–0.96, p = 0.0077. Changes in FLI were significantly associated with changes in FPG during follow-up (p<0.0001). When compared to a full model including the diabetes risk score, FPG, HbA1C and FLI, only HbA1C added a significant prediction information (AUROC: 72.8% for full model vs 69.4% for the model without HbA1C; p = 0.028), while the removal of FLI to the full model did not alter its predictive value (AUROC 72.2%). The predictive value for NOD conversion was not significantly better for HOMA-IR compared to FLI (AUROC: 69.3 vs 63.7%, p = 0.067).ConclusionsFLI is a simple, practical score to further stratify the risk of conversion to NOD or the possibility of prediabetes reversion in clinical practice, independently of classical glucose parameters.Trial registrationClincialTrials.gov number NCT01218061 and NCT01432509.
Highlights
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide
fatty liver index (FLI) is a simple, practical score to further stratify the risk of conversion to new-onset diabetes (NOD) or the possibility of prediabetes reversion in clinical practice, independently of classical glucose parameters
We described the study population according to the diabetes status at the end of follow-up using classical description parameters (population size (%), mean ± standard deviations or median (25th-75th percentiles), according to the distribution)
Summary
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. Peripheral insulin resistance in adipose tissue promotes lipolysis and the release of free fatty acids (FFA) in the bloodstream that are taken up by the liver to promote hepatic steatosis [4]. Concordant observational studies suggest that NAFLD is a predictor of metabolic diseases, such as T2D [6]. A study has demonstrated that liver steatosis assessed by abdominal ultrasonography predicts NOD independently of all markers of the MetS [7]. In patients at metabolic risk, nonalcoholic fatty liver disease is a strong and highly prevalent predictor for type 2 diabetes. We studied the association between the FLI and the conversion to new-onset diabetes (NOD) or prediabetes reversion in patients with prediabetes
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