Highlights
- •The association between NAFLD and diabetes rarely has been studied in young adults.
- •NAFLD was associated with a 5-fold increased risk of diabetes in young adults.
- •There was a J-shaped relationship between the FLI and the risk of diabetes.
- •FLI can be a tool for identifying young NAFLD patients at higher risk for diabetes.
Abstract
Background
Nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of diabetes
but has been rarely investigated in young adults. In this study, we investigated the
relationship between NAFLD and incident diabetes risk in young adults using nationwide
Korean population data.
Methods
This population-based cohort study from the Korean National Health Insurance Service
included adults aged 20 through 39 years who underwent a health examination from 2009
to 2012. NAFLD was defined as a fatty liver index (FLI) ≥60 in the absence of alcohol
consumption of ≥30 g/day. Newly diagnosed diabetes during follow-up was identified
using claims data. Cox regression was used to calculate the hazard ratio for incident
diabetes after adjusting for classical confounders.
Findings
Among the 5,254,786 participants, 9.3% had an FLI ≥60. During the median follow-up
of 8.6 years, 91,885 cases of incident diabetes occurred. In multivariable analysis,
the risk of incident diabetes was significantly higher in the NAFLD group than the
control group (adjusted hazard ratio = 4.97, 95% confidence interval, 4.90–5.05).
Stratified analyses showed higher associations in those who were ≥30 years, male,
obese, smokers, alcohol consumers, and did not regularly exercise (all P < 0.001).
Conclusions
NAFLD is associated with a five-fold increased risk of incident diabetes in young
adults. These results suggest an independent high risk for incident diabetes in young
adults and underscore the importance of paying early attention to patients who develop
NAFLD before middle age.
Abbreviations:
BMI (body mass index), CI (confidence interval), CKD (chronic kidney disease), FLI (fatty liver index), HR (hazard ratio), ICD (International Classification of Diseases), NAFLD (nonalcoholic fatty liver disease), NHIS (National Health Insurance System), WC (waist circumference)Keywords
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Article info
Publication history
Published online: August 16, 2021
Accepted:
August 10,
2021
Received:
May 11,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
