Nonalcoholic fatty liver disease in relation to the remission and progression along the glycemic continuum. Issue 9 (26th September 2022) - Xin, Zhuojun
Abstract: Background: The study aimed to explore the associations of nonalcoholic fatty liver disease (NAFLD) with the remission and progression along the glycemic continuum. Methods: This prospective cohort study was performed among the general population in 2010–2015. NAFLD was defined as ultrasound‐detected hepatic steatosis with absence of excessive alcohol consumption and other hepatic diseases. Remission of type 2 diabetes referred to glycated hemoglobin <6.5% without hypoglycemic agents for ≥3 months. Prediabetes remission referred to normalization of blood glucose. Multivariable logistic analysis was applied to identify the risk of glycemic metabolic transition. Results: During a median follow‐up of 4.3 years, participants with NAFLD had a significantly higher risk of progressing from normal glucose tolerance to diabetes (3.36 [1.60–7.07]) and lower likelihood of diabetes remission (0.48 [0.30–0.78]). Associations in participants with overweight or obesity and higher probability of hepatic fibrosis remained consistent. Results related to the effect of NAFLD on the specific glucose parameters were generally in line with the changes of glycemic status. NAFLD improvement decreased the risk of prediabetes progressing to diabetes (0.50 [0.32–0.80]) and increased the probability of prediabetes remission (2.67 [1.49–4.79]). NAFLD tended to show the most significant association with glycemic progression and decreased the likelihood in remission of prediabetes and diabetes. Conclusions: Presence of NAFLD increased risk of glycemic progression and decreased likelihood of remission. NAFLD improvement mitigated glycemic deterioration, whereas NAFLD progression impeded the chance of remission. The results emphasized joint management of NAFLD and diabetes and further focused on liver‐specific subgroups of diabetes to tailor early intervention. Abstract : Highlights To what extent NAFLD is associated with glycemic remission among the general population remains unclear. The study elaborated that presence of NAFLD and fibrosis status decreased the chance of glycemic remission whereas NAFLD improvement mitigated glycemic deterioration, emphasizing joint management to liver‐focused subgroups of diabetes. 摘要: 背景: 本研究旨在探讨非酒精性脂肪性肝病(NAFLD)与糖尿病进展的关系。 方法: 这项前瞻性队列研究于2010‐2015年在普通人群中进行。NAFLD被定义为超声检测到的肝脏脂肪变性，没有过量饮酒和其他肝病。2型糖尿病的缓解是指在≥3个月内未服用降糖药的患者糖化血红蛋白低于6.5%。糖尿病前期缓解是指血糖正常化。多变量Logistic分析用于识别血糖代谢转换的风险。 结果: 在平均4.3年的随访期间，NAFLD的参与者从正常糖耐量(NGT)进展到糖尿病的风险较高[3.36(1.60‐7.07)]，而糖尿病缓解的可能性较低[0.48(0.30‐0.78)]。超重或肥胖与较高的肝纤维化概率之间的关联仍然是一致的。NAFLD对特定血糖参数的影响与血糖状态的变化基本一致。NAFLD的改善降低了糖尿病前期进展为糖尿病的风险[0.50(0.32‐0.80)]，并增加了糖尿病前期缓解的可能性[2.67(1.49‐4.79)]。NAFLD倾向于表现出与血糖进展最显著的相关性，并降低了糖尿病前期和糖尿病缓解的可能性。 结论: NAFLD的存在增加了高血糖进展的风险，降低了缓解的可能性。NAFLD的改善可缓解血糖恶化，而NAFLD的进展则阻碍缓解的机会。应该强调NAFLD和糖尿病的联合管理，并进一步关注糖尿病的肝脏特异性亚组，以量身定制早期干预。