Liver steatosis as a predictor of incident diabetes in adults: a prospective evaluation in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Increasing epidemiological evidence suggests a bidirectional relationship between non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes, and that NAFLD may precede and/or promote the development of diabetes. This study aimed to investigate whether liver steatosis is associated with the incidence of diabetes in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The ELSA-Brasil is an occupational cohort study of active or retired civil servants, aged 35-74 years, in six capital cities in Brazil. We excluded participants with diabetes at baseline, those who reported excessive alcohol consumption or with missing information on relevant covariates, and those with self-referred hepatitis or cirrhosis. In total, 8,166 individuals participated, and the mean duration of follow-up was 3.8 years. The Cox proportional regression model was used to estimate the adjusted hazard ratio (HR) for the associations. Abdominal ultrasonography was used to detect liver steatosis. In the follow-up period, the cumulative incidence of diabetes was 5.25% in the whole sample, 7.83% and 3.88% in the groups with and without hepatic steatosis, respectively (p < 0.001). Compared to those without steatosis, individuals with hepatic steatosis had an increased risk of developing diabetes (HR = 1.31; 95%CI: 1.09-1.56) after adjustment for potential confounders, including body mass index (BMI). Hepatic steatosis was an independent predictor of incident diabetes in the ELSA-Brasil cohort study. Physicians should encourage changes in lifestyle and screen for diabetes in patients with fatty liver.

越来越多的流行病学证据表明，非酒精性脂肪性肝病（non-alcoholic fatty liver disease, NAFLD）与2型糖尿病之间存在双向关联，且非酒精性脂肪性肝病可能先于糖尿病发生并/或促进糖尿病的进展。本研究旨在探讨巴西成人健康纵向研究（Brazilian Longitudinal Study of Adult Health, ELSA-Brasil）中，肝脏脂肪变性与糖尿病发病风险的关联。该队列研究为一项职业性队列研究，研究对象为巴西6个省会城市中年龄介于35~74岁的在职或退休公务员。本研究排除了基线已确诊糖尿病者、报告过量饮酒者、相关协变量信息缺失者，以及自述罹患肝炎或肝硬化者。最终共有8166名受试者纳入分析，平均随访时长为3.8年。本研究采用Cox比例风险回归模型估算关联的校正后风险比（hazard ratio, HR）。研究采用腹部超声检查检测肝脏脂肪变性。随访期间，全样本的糖尿病累积发病率为5.25%；合并肝脏脂肪变性组与未合并组的糖尿病累积发病率分别为7.83%与3.88%（p < 0.001）。在校正包括体质量指数（body mass index, BMI）在内的潜在混杂因素后，与未合并肝脏脂肪变性的受试者相比，合并肝脏脂肪变性者的糖尿病发病风险升高（HR=1.31；95%CI：1.09~1.56）。在ELSA-Brasil队列研究中，肝脏脂肪变性是糖尿病新发事件的独立预测因素。临床医师应鼓励脂肪肝病患者改善生活方式，并对其进行糖尿病筛查。