The University of Southampton
University of Southampton Institutional Repository

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
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.

1468-3288
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), 962-969. (doi:10.1136/gutjnl-2020-322572).

Record type: Article

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.

Text
NAFLD diabetes risk R1 clean copy - Accepted Manuscript
Download (222kB)
Text
Table S1 - Accepted Manuscript
Download (165kB)
Text
Table S2 NOS - Accepted Manuscript
Download (20kB)
Text
Fig 1_PRISMA Flow Chart - Accepted Manuscript
Restricted to Repository staff only
Request a copy
Text
Fig 2_all - Accepted Manuscript
Restricted to Repository staff only
Request a copy
Text
Fig 3_severity_R1 - Accepted Manuscript
Restricted to Repository staff only
Request a copy
Slideshow
Figure S1_metaregressions - Accepted Manuscript
Restricted to Repository staff only
Request a copy
Slideshow
Figure S2_metaninf - Accepted Manuscript
Restricted to Repository staff only
Request a copy
Slideshow
Figure S3_funnel - Accepted Manuscript
Restricted to Repository staff only
Request a copy

Show all 9 downloads.

More information

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
ORCID for Christopher Byrne: ORCID iD orcid.org/0000-0001-6322-7753

Catalogue record

Date deposited: 19 Aug 2020 16:32
Last modified: 28 Apr 2022 05:27

Export record

Altmetrics

Contributors

Author: Alessandro Mantovani
Author: Graziana Petracca
Author: Giorgia Beatrice
Author: Herbert Tilg
Author: Giovanni Targher

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×