Nonalcoholic fatty liver disease and the risk of insulin-requiring gestational diabetes

Sang Youn You,Kyungdo Han,Seung-Hawn Lee,Mee Kyoung Kim

doi:10.1186/s13098-021-00710-y

Abstract

BackgroundNonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases; however, there has been little research into its impact on gestational diabetes mellitus (GDM).MethodsThis study included 308,095 women registered in the Korean National Health Insurance Service database, who delivered between 2011 and 2015 and received a health examination within 52 weeks before pregnancy. Insulin-requiring GDM was defined as no insurance claims for diabetes mellitus and a fasting blood glucose level of < 126 mg/dL before pregnancy, and initiation of insulin treatment during pregnancy. A fatty liver index (FLI) was calculated using body mass index, waist circumference, and blood triglyceride and γ-glutamyl transferase levels. FLI scores < 30 ruled out hepatic steatosis, while FLI scores ≥ 60 indicated NAFLD.ResultsThe prevalence of NAFLD was 0.8% (2355/308,095) and 1984 (0.6%) subjects developed insulin-requiring GDM. FLIs of 30–59 and ≥ 60 were significantly associated with increased risk of insulin-requiring GDM (odds ratio [OR] 3.50; 95% confidence interval [CI] 2.99–4.10; OR 4.19; 95% CI 3.37–5.23), respectively. Further exploration of the association of FLI with GDM across FLI decile categories revealed a steady increase in OR across the categories. The association was more prominent among those without metabolic syndrome.ConclusionNAFLD in women is an independent risk factor for insulin-requiring GDM.

Highlights

Nonalcoholic fatty liver disease (NAFLD) is defined as an increase in liver fat content, in the absence of any secondary cause of steatosis [1, 2]
These findings suggest that the utility of the fatty liver index (FLI) as a risk factor for gestational diabetes mellitus (GDM) may be more valid in these subpopulations
In this study, we demonstrated that the presence of NAFLD before pregnancy was associated with an increased risk of insulin-requiring GDM

Summary

Introduction

Nonalcoholic fatty liver disease (NAFLD) is defined as an increase in liver fat content, in the absence of any secondary cause of steatosis [1, 2]. Many longitudinal studies have shown that NAFLD is an independent risk factor for developing type 2 DM [3, 4]. We conducted a large population-based study involving more than 300,000 pregnant women in Korea who received a health examination within 52 weeks before pregnancy to examine the prognostic significance of NAFLD before pregnancy for the risk of severe GDM. Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases; there has been little research into its impact on gestational diabetes mellitus (GDM)

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Results

Conclusion