당뇨전기 환자에서 지방간질환과 당뇨병의 연관성 및 복부 둘레와 체질량지수 변화가 미치는 영향

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) and prediabetes are well-known risk factors for diabetes. However, few studies have been performed about the risk of diabetes in subjects with prediabetes in the presence of NAFLD. In addition, little information was known about the impact of waist circumference (WC) and body mass index (BMI) changes on the development of diabetes. In this study, we examined the association of NAFLD with diabetes and the impact of WC and BMI changes in subjects with prediabetes. Methods: We enrolled 6,240 subjects with prediabetes who underwent general routine health evaluations in 2007 and returned for follow-up examinations in 2008 -2013 at least one time. Subjects were stratified by WC and BMI changes into three groups. The RRs of NAFLD for diabetes was evaluated. Results: The prevalence of NAFLD in study participants was 45.4 % (2,830/6,240). Subjects with NAFLD had higher BMI, WC, HbA1c levels, blood pressure levels, blood lipid levels, and also higher ALT levels (P < 0.001). During the follow-up, the total incidence of diabetes was 8.093 %. Subjects with NAFLD at baseline had a higher incidence of diabetes and the adjusted relative ratios (RRs) were 2.181 [95% confidence interval (CI), 1.778 to 2.674]. Furthermore, the RRs were closely related to WC changes. The adjusted RRs for diabetes according to WC change (≤ 0.0 cm, 0 cm to 3.0 cm, and > 3.0 cm) were 1.953 (95% CI, 1.365 to 2.794), 1.996 (95% CI, 1.407 to 2.833), and 2.302 (95% CI, 1.598 to 3.314), respectively. Furthermore, the RRs were also closely related to BMI changes and the adjusted RRs for diabetes according to BMI change (< -0.35 kg/m2, -0.35 kg/m2 to 0.35 kg/m2, and > 0.35 kg/m2) were 1.633 (95% CI, 1.121 to 2.380), 1.995 (95% CI, 1.415 to 2.811), and 2.924 (95% CI, 2.053 to 4.165), respectively. Conclusion: There was a strong and independent association between NAFLD and diabetes in Korean subjects with prediabetes, and this relationship was closely related to WC and BMI changes.