Nonalcoholic fatty liver disease and risk of incident diabetes mellitus: an updated meta-analysis of 501,022 adult individuals
Nonalcoholic fatty liver disease and risk of incident diabetes mellitus: an updated meta-analysis of 501,022 adult individuals
OBJECTIVE: Follow-up studies have shown that non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of incident diabetes, but currently, it is uncertain whether this risk changes with increasing severity of NAFLD. We performed a meta-analysis of relevant studies to quantify the magnitude of the association between NAFLD and risk of incident diabetes.
DESIGN: We systematically searched PubMed, Scopus and Web of Science databases from January 2000 to June 2020 using predefined keywords to identify observational studies with a follow-up duration of at least 1 year, in which NAFLD was diagnosed by imaging techniques or biopsy. Meta-analysis was performed using random-effects modelling.
RESULTS: 33 studies with 501 022 individuals (30.8% with NAFLD) and 27 953 cases of incident diabetes over a median of 5 years (IQR: 4.0-19 years) were included. Patients with NAFLD had a higher risk of incident diabetes than those without NAFLD (n=26 studies; random-effects HR 2.19, 95% CI 1.93 to 2.48;
I
2
=91.2%). Patients with more 'severe' NAFLD were also more likely to develop incident diabetes (n=9 studies; random-effects HR 2.69, 95% CI 2.08 to 3.49;
I
2
=69%). This risk markedly increased across the severity of liver fibrosis (n=5 studies; random-effects HR 3.42, 95% CI 2.29 to 5.11;
I
2=44.6%). All risks were independent of age, sex, adiposity measures and other common metabolic risk factors. Sensitivity analyses did not alter these findings. Funnel plots did not reveal any significant publication bias.
CONCLUSION: This updated meta-analysis shows that NAFLD is associated with a ~2.2-fold increased risk of incident diabetes. This risk parallels the underlying severity of NAFLD.
962-969
Mantovani, Alessandro
19fc8a1f-60fe-403a-b70e-6b6884929e03
Petracca, Graziana
3e3ee519-6eb8-48ef-b908-5a9298bb7f9b
Beatrice, Giorgia
d563598a-2878-41a3-a6ea-6a83050d73f4
Tilg, Herbert
ef8597c1-ea86-4416-aa92-be76c96d65fa
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
Targher, Giovanni
043e0811-b389-4922-974e-22e650212c5f
Mantovani, Alessandro
19fc8a1f-60fe-403a-b70e-6b6884929e03
Petracca, Graziana
3e3ee519-6eb8-48ef-b908-5a9298bb7f9b
Beatrice, Giorgia
d563598a-2878-41a3-a6ea-6a83050d73f4
Tilg, Herbert
ef8597c1-ea86-4416-aa92-be76c96d65fa
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
Targher, Giovanni
043e0811-b389-4922-974e-22e650212c5f
Mantovani, Alessandro, Petracca, Graziana, Beatrice, Giorgia, Tilg, Herbert, Byrne, Christopher and Targher, Giovanni
(2020)
Nonalcoholic fatty liver disease and risk of incident diabetes mellitus: an updated meta-analysis of 501,022 adult individuals.
Gut, 70 (5), .
(doi:10.1136/gutjnl-2020-322572).
Abstract
OBJECTIVE: Follow-up studies have shown that non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of incident diabetes, but currently, it is uncertain whether this risk changes with increasing severity of NAFLD. We performed a meta-analysis of relevant studies to quantify the magnitude of the association between NAFLD and risk of incident diabetes.
DESIGN: We systematically searched PubMed, Scopus and Web of Science databases from January 2000 to June 2020 using predefined keywords to identify observational studies with a follow-up duration of at least 1 year, in which NAFLD was diagnosed by imaging techniques or biopsy. Meta-analysis was performed using random-effects modelling.
RESULTS: 33 studies with 501 022 individuals (30.8% with NAFLD) and 27 953 cases of incident diabetes over a median of 5 years (IQR: 4.0-19 years) were included. Patients with NAFLD had a higher risk of incident diabetes than those without NAFLD (n=26 studies; random-effects HR 2.19, 95% CI 1.93 to 2.48;
I
2
=91.2%). Patients with more 'severe' NAFLD were also more likely to develop incident diabetes (n=9 studies; random-effects HR 2.69, 95% CI 2.08 to 3.49;
I
2
=69%). This risk markedly increased across the severity of liver fibrosis (n=5 studies; random-effects HR 3.42, 95% CI 2.29 to 5.11;
I
2=44.6%). All risks were independent of age, sex, adiposity measures and other common metabolic risk factors. Sensitivity analyses did not alter these findings. Funnel plots did not reveal any significant publication bias.
CONCLUSION: This updated meta-analysis shows that NAFLD is associated with a ~2.2-fold increased risk of incident diabetes. This risk parallels the underlying severity of NAFLD.
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NAFLD diabetes risk R1 clean copy
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Table S2 NOS
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Accepted/In Press date: 9 August 2020
e-pub ahead of print date: 16 September 2020
Identifiers
Local EPrints ID: 443254
URI: http://eprints.soton.ac.uk/id/eprint/443254
ISSN: 1468-3288
PURE UUID: 8b9925de-8a39-4adb-ac0a-304dec9a1dad
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Date deposited: 19 Aug 2020 16:32
Last modified: 17 Mar 2024 05:49
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Contributors
Author:
Alessandro Mantovani
Author:
Graziana Petracca
Author:
Giorgia Beatrice
Author:
Herbert Tilg
Author:
Giovanni Targher
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