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Non-alcoholic fatty liver disease independently predicts prediabetes during a 7-year prospective follow-up

Authors

  • Shira Zelber-Sagi,

    Corresponding author
    1. School of Public Health, Haifa University, Haifa, Israel
    • Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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    • Both authors contributed equally to this study and share first authorship.
  • Roni Lotan,

    1. Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
    2. The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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    • Both authors contributed equally to this study and share first authorship.
  • Oren Shibolet,

    1. Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
    2. The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Muriel Webb,

    1. Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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  • Assaf Buch,

    1. Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
    2. The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Dorit Nitzan-Kaluski,

    1. The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Zamir Halpern,

    1. Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
    2. The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Erwin Santo,

    1. Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
    2. The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Ran Oren

    1. Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
    2. The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Correspondence

Shira Zelber-Sagi, RD, PhD, Liver Unit, Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel

Tel: +972 3 6973984

Fax: +972 3 6974622

e-mail: zelbersagi@bezeqint.net

Abstract

Background & Aims

Non-alcoholic fatty liver disease (NAFLD) is suspected to confer an increased risk for developing type 2 diabetes (DM). However, only a few prospective studies evaluated NAFLD as a predictor for DM, most did not adjust for the full range of potential cofounders and none used an objectively quantified degree of steatosis. Our aim was to evaluate the independent role of NAFLD in predicting the development of pre-DM in a 7-year prospective follow-up of healthy volunteers.

Methods

A prospective cohort of a subsample of the Israeli National Health Survey evaluated at baseline and after 7 years by identical protocols. Metabolic parameters and ultrasonographic evidence of NAFLD were evaluated in 213 subjects, without known liver disease or history of alcohol abuse. Exclusion criteria were pre-DM at the baseline survey. Steatosis was quantified by ultrasound with the hepato-renal ultrasound index (HRI).

Results

The study included 141 volunteers (mean age 48.78 ± 9.68, 24.82% with NAFLD) without pre-DM/DM at baseline. Both NAFLD on regular US (OR=2.93, 1.02–8.41 95%CI) and HRI (OR=7.87, 1.83–33.82) were independent predictors for the development of pre-DM, adjusting for age, gender, BMI, family history of DM, baseline insulin, adiponectin and glucose. Further adjustment for physical activity and dietary intake did not weaken the association. Furthermore, NAFLD was a stronger predictor for pre-DM than the metabolic syndrome. Subjects with both NAFLD and glucose ≥89 had 93.3% incidence rate of pre-DM.

Conclusion

Non-alcoholic fatty liver disease is a strong and independent risk factor for pre-DM in the general adult population; thus, NAFLD patients should be classified as a population at risk.

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