Data Sheet 1_Sugar-sweetened beverage consumption predicts metabolic associated fatty liver disease in patients with type 2 diabetes mellitus.docx

BackgroundMetabolic associated fatty liver disease (MAFLD) is a leading cause of chronic liver disease worldwide, with heightened prevalence and progression risks in individuals with type 2 diabetes mellitus (T2DM). Emerging evidence suggests dietary factors, particularly sugar-sweetened beverage (SSB) consumption, may exacerbate metabolic dysregulation, yet this relationship remains underexplored in MAFLD populations.
MethodWe enrolled 3,305 T2DM patients from Taizhou University Hospital, classifying them into MAFLD and non-MAFLD groups via liver ultrasonography. SSB consumption was quantified as weekly intake. Clinical parameters and SSB consumption were analyzed using logistic regression. External validation leveraged NHANES data, focusing on total sugar intake and surrogate markers.
ResultsMAFLD patients exhibited significantly higher BMI, waist/hip ratios, and SSB consumption than non-MAFLD counterparts (p<0.001). SSB consumption emerged as an independent MAFLD risk factor, with dose-dependent escalation in MAFLD odds. The MAFLD model based on glycometabolism (MMBG), integrating SSB consumption, C-peptide, and glucose, outperformed traditional indices, such as TyG, VAI, and AIP, achieving superior AUC (0.712 vs. 0.631–0.666), enhanced clinical utility and higher Brier scores (p<0.05, respectively). NHANES validation confirmed BMI, central obesity, hyperglycemia, and sugar intake as MAFLD predictors.
ConclusionSSB consumption independently predicts MAFLD risk in T2DM patients, with synergistic effects from dysregulated glycometabolism. The MMBG model, incorporating SSB consumption and glycometabolic parameters, offers a robust tool for early MAFLD risk identification and personalized interventions.

背景：代谢相关脂肪性肝病（Metabolic Associated Fatty Liver Disease, MAFLD）是全球慢性肝病的首要病因，2型糖尿病（Type 2 Diabetes Mellitus, T2DM）患者的MAFLD患病率与疾病进展风险均显著升高。现有研究证据显示，膳食因素尤其是含糖饮料（Sugar-Sweetened Beverage, SSB）的摄入可能加重代谢紊乱，但该关联在MAFLD人群中仍未得到充分探究。
方法：本研究从台州学院附属医院纳入3305名2型糖尿病患者，通过肝脏超声检查将其分为MAFLD组与非MAFLD组。以每周摄入量量化含糖饮料摄入情况，采用logistic回归分析临床指标与含糖饮料摄入的关联。本研究采用美国国家健康与营养检查调查（National Health and Nutrition Examination Survey, NHANES）数据开展外部验证，聚焦总糖摄入与替代标志物。
结果：与非MAFLD患者相比，MAFLD患者的BMI、腰臀比以及含糖饮料摄入量均显著更高（p<0.001）。含糖饮料摄入是MAFLD的独立危险因素，且MAFLD患病风险随含糖饮料摄入量增加呈剂量依赖性升高。本研究构建的基于糖代谢的MAFLD预测模型（MMBG）整合了含糖饮料摄入、C肽与血糖水平，其表现优于传统指标如甘油三酯葡萄糖乘积指数（TyG）、内脏脂肪指数（VAI）、动脉粥样硬化性血脂指数（AIP），AUC达0.712（传统指标仅为0.631~0.666），临床应用价值更高，布里尔评分亦更优（均p<0.05）。NHANES外部验证证实，BMI、中心性肥胖、高血糖与糖摄入均为MAFLD的预测因素。
结论：在2型糖尿病患者中，含糖饮料摄入可独立预测MAFLD患病风险，且与糖代谢紊乱存在协同效应。本研究构建的整合了含糖饮料摄入与糖代谢参数的MMBG模型，可为MAFLD的早期风险识别与个性化干预提供可靠工具。