medwireNews: The degree of non-alcoholic fatty liver disease (NAFLD), estimated by fatty liver index (FLI), is significantly associated with the risk for progression to type 2 diabetes in people with prediabetes, Spanish study findings indicate.
Miquel Bennasar-Veny (University of the Balearic Islands, Palma de Mallorca, Spain) and co-investigators say: “FLI-based assessment of NAFLD in subjects with pre-diabetes in routine clinical practice could allow the adoption of effective measures to prevent and reduce their progression to [type 2 diabetes].”
The findings are based on a prospective analysis of data for 16,648 adults aged 20–65 years (mean 45 years, 73% men) with prediabetes (fasting plasma glucose 100–125 mg/dL; 5.6–6.9 mmol/L) who underwent occupational health assessments between 2012 and 2013.
Of these, 38.6% had a no hepatic steatosis, defined as an FLI below 30 on a scale of 0 to 100, based on triglyceride, BMI, waist circumference, and γ-glutamyltransferase measurements. A further 25.9% had an FLI of 30 to 60, indicating an intermediate status, and 35.5% had hepatic steatosis, with an FLI above 60.
During 5 years of follow-up, 22.2% of study participants were diagnosed with type 2 diabetes, corresponding to a progression rate of 4.5% per year.
The incidence rates were similar for men and women, at 22.1% and 22.6%, respectively, but differed significantly according to baseline FLI.
Specifically, 0.3% of individuals with an FLI below 30 progressed to diabetes, compared with 7.8% of those in the intermediate category, and 56.7% of those with an FLI above 60 at baseline.
Of note, a significantly higher proportion of women with an FLI over 60 progressed to diabetes than did men in the same category, at rates of 84.0% and 51.2%, respectively.
Bennasar-Veny and team suggest: “Although women are generally less likely to suffer from hepatic steatosis, once they do, they might present a higher risk of developing [type 2 diabetes] than males.”
However, when the data were adjusted for age, diet, physical activity, fasting plasma glucose, blood pressure, social class, and smoking, the risk for progression to type 2 diabetes was higher in men than women with an FLI over 60, at respective hazard ratios of 6.9 and 5.8 relative to people with an FLI below 60.
Writing in BMJ Open, Bennasar-Veny and co-authors conclude that their “study highlights the importance of FLI as an easily calculated and valuable early indicator for high risk of [type 2 diabetes] in subjects with pre-diabetes.”
They add that using the FLI in primary care “would benefit patients at greater risk, allowing more careful monitoring and providing an opportunity for early interventions to prevent and reduce both the progression of hepatic disease and type 2 diabetes.”
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