NAFLD ups DM risk in normal-weight adults

  • Sinn DH & al.
  • Eur J Endocrinol
  • 1 Jun 2019

  • International Clinical Digest
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Takeaway

  • Presence and severity of nonalcoholic fatty liver disease in normal-weight adults (lean NAFLD) are independently associated with increased risk for diabetes mellitus (DM).

Why this matters

  • Although NAFLD phenotype is classically an obese/overweight individual with features of metabolic syndrome, about 8%-19% of cases occur in patients with BMI 2.
  • Individuals with lean NAFLD have higher diabetes risk than non-NAFLD overweight/obese individuals.
  • Careful monitoring for metabolic abnormalities is warranted.

Study design

  • Korean cohort study of 51,463 adults (mean age, 48.7±9.1 years) without diabetes, liver disease, hepatitis, or cancer, undergoing regular health screening. 
  • Normal weight: BMI between 18.5 and 22.9 kg/m2.
  • 10.3% had lean NAFLD; 46.1% had overweight/obese NAFLD.
  • Funding: None.

Key results

  • 5370 participants developed diabetes over median 4-year follow-up.
  • 10-year was almost double in lean patients with vs without NAFLD (27.3% vs 14.1%).
  • In fully adjusted models using lean non-NAFLD as a reference, risk for diabetes was higher with:
    • Lean NAFLD (HR=1.18; 95% CI, 1.03-1.35).
    • Overweight/obese individuals with NAFLD (HR=1.45; 95% CI, 1.34-1.57), but not those without NAFLD.
  • Risk with lean NAFLD was higher (P<.001 with intermediate-high hr="2.73;" ci vs low nafld fibrosis score>
  • Association was stronger among patients aged

Limitations

  • Retrospective design.
  • Asian population.