Nonalcoholic fatty liver disease and risk of diabetes: A prospective study in China

Xiuhua Shen, Jianfang Cai, Jingsheng Gao, Anand Vaidya, Xuemei Liu, Wen Li, Shuohua Chen, Yong Zhou, Yinge Li, Yanmin Zhang, Jianqiu Zhao, Frank B. Hu, Shouling Wu, Xiang Gao

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Objective: We aimed to investigate whether liver steatosis severity affects the risk of developing diabetes in a large cohort study. Methods: We prospectively examined the association in 41,650 Chinese adults with negative hepatitis-B surface antigen who were free of alcohol consumption, diabetes, and liver cirrhosis at baseline. Cox proportional models were used to estimate the risk of diabetes after a mean of 3.6 years of follow-up. Nonalcoholic fatty liver disease (NAFLD) was assessed with hepatic ultrasonography. Elevated alanine transaminase (ALT) was defined as ALT concentrations >19 and >30 U/L in females and males, respectively. Diabetes was defined as a fasting glucose 7.0 mmol/L or treatment with hypoglycemic medication. Results: Liver steatosis severity was significantly associated with higher risks of developing diabetes (adjusted hazard ratio [HR] for severe vs. without NAFLD = 2.66, 95% confidence interval [CI]: 2.17-3.25, P-trend<.001) and impaired fasting glucose (fasting glucose between 5.6 and 6.9 mmol/L, adjusted HR = 1.36, 95% CI: 1.16-1.59, P-trend<.001), as well as a faster increase rate of fasting glucose concentrations (P-trend<.001), during 3.6 years of follow-up. Elevated ALT was also associated with incident diabetes (HR = 1.12, 95% CI: 1.02-1.22), adjusting for NAFLD and other covariates. Conclusion: We observed a dose-response relationship between liver steatosis severity and increased diabetes risk, and ALT may predict incident diabetes independently of NAFLD. (Endocr Pract.

Original languageEnglish (US)
Pages (from-to)823-832
Number of pages10
JournalEndocrine Practice
Issue number9
StatePublished - Sep 2018

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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