Abstract
AimsThe relationship between nonalcoholic fatty liver disease and incident metabolic syndrome in metabolically healthy subjects is unknown. We aimed to investigate whether nonalcoholic fatty liver disease is a predictor of future metabolic syndrome in metabolically healthy subjects.Materials and methodsSubjects who underwent health evaluation at least twice between 2009 and 2015 from the National Health Insurance Service-National Sample Cohort in South Korea were included. Patients without obesity who had no metabolic syndrome components were finally analyzed (n = 28,880). The definition of nonalcoholic fatty liver disease was based on both the hepatic steatosis and fatty liver indices. The incidence of metabolic syndrome, prediabetes/type 2 diabetes, hypertension, and dyslipidemia was compared between the subjects with and without nonalcoholic fatty liver disease.ResultsThe presence of nonalcoholic fatty liver disease was associated with a higher risk of incident metabolic syndrome, prediabetes/type 2 diabetes, hypertension, and dyslipidemia in the entire cohort (metabolic syndrome: adjusted hazard ratio, 2.10; 95% confidence interval, 1.18–3.71; prediabetes/type 2 diabetes: adjusted hazard ratio, 1.42; 95% confidence interval, 1.06–1.90; hypertension: adjusted hazard ratio, 2.36; 95% confidence interval, 1.35–4.12; dyslipidemia: adjusted hazard ratio, 1.49; 95% confidence interval, 1.07–2.06). A similar finding was observed in the age-, sex-, smoking status-, and body mass index-based 1:5 propensity score-matched cohort of 1,092 subjects (metabolic syndrome: adjusted hazard ratio, 3.56; 95% confidence interval, 1.79–7.07; prediabetes/type 2 diabetes: adjusted hazard ratio, 1.97; 95% confidence interval, 1.04–3.73; hypertension: adjusted hazard ratio, 2.57; 95% confidence interval, 1.35–4.88; dyslipidemia: adjusted hazard ratio, 1.61; 95% confidence interval, 1.12–2.32).ConclusionsNonalcoholic fatty liver disease is an early predictor of metabolic dysfunction even in metabolically healthy populations.
Highlights
A bidirectional relationship between nonalcoholic fatty liver disease (NAFLD) and metabolic disease has recently been highlighted [1,2,3,4,5]
The presence of nonalcoholic fatty liver disease was associated with a higher risk of incident metabolic syndrome, prediabetes/type 2 diabetes, hypertension, and dyslipidemia in the entire cohort
Nonalcoholic fatty liver disease is an early predictor of metabolic dysfunction even in metabolically healthy populations
Summary
A bidirectional relationship between nonalcoholic fatty liver disease (NAFLD) and metabolic disease has recently been highlighted [1,2,3,4,5]. The presence of NAFLD has been reported to be associated with an increased risk of metabolic dysfunction in patients with one or more metabolic syndrome components [11], which raises the issue of whether NAFLD is a surrogate of metabolic disease in a population without metabolic syndrome. This issue is clinically relevant because NAFLD is common in the general population [12], and its association with cardiovascular risks not attributed to metabolic dysfunction has been reported [13,14]. If NAFLD is a surrogate of metabolic disease even in those without any metabolic syndrome components, it will provide a basis for starting an earlier intervention, such as stricter lifestyle modification
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