Synergistic effect of non-alcoholic fatty liver disease and history of gestational diabetes to increase risk of type 2 diabetes
Synergistic effect of non-alcoholic fatty liver disease and history of gestational diabetes to increase risk of type 2 diabetes
Whether non-alcoholic fatty liver disease (NAFLD) improves risk prediction for subsequent type 2 diabetes mellitus (T2DM) in women with prior gestational diabetes mellitus (pGDM) is uncertain. We examined the combined effects of NAFLD and pGDM on risk prediction for incident T2DM. This retrospective cohort study included 97,347 Korean parous women without diabetes mellitus at baseline whose mean (SD) age was 39.0 (7.8) years. Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident T2DM according to self-reported pGDM and ultrasound-diagnosed NAFLD at baseline. When combined with conventional diabetes risk factors, the incremental predictive ability of NAFLD and pGDM to identify incident T2DM was assessed. During a median follow-up of 3.9 years, 1,515 cases of incident T2DM occurred. Multivariable-adjusted HRs (95% confidence intervals [CIs]) for incident T2DM comparing pGDM alone, NAFLD alone, and both NAFLD and pGDM to the reference (neither NAFLD nor pGDM) were 2.61 (2.06–3.31), 2.26 (1.96–2.59), and 6.45 (5.19-8.00), respectively (relative excess risk of interaction = 2.58 [95% CI, 1.21–3.95]). These associations were maintained after adjusting for insulin resistance, body mass index, and other potential confounders as time-dependent covariates. The combination of NAFLD and pGDM improved risk prediction for incident T2DM (based on Harrell’s C−index, also known as the concordance index, and net reclassification improvement) compared to conventional diabetes risk factors. In conclusion, NAFLD synergistically increases the risk of subsequent T2DM in women with pGDM. The combination of NAFLD and pGDM improves risk prediction for T2DM.
cohort study, gestational diabetes mellitus, non-alcoholic fatty liver disease, type 2 diabetes mellitus
901-911
Cho, Yoosun
18ca53a3-7cda-4567-ac42-88bec4a652e0
Chang, Yoosoo
71f9b27c-a9a0-4014-aaab-52ad46463a4d
Ryu, Seungho
d3702257-53d3-41af-a74a-31de721d1719
Wild, Sarah H.
cdbb4f1e-c4a4-419a-bbd1-d018389de831
Byrne, Christopher D.
1370b997-cead-4229-83a7-53301ed2a43c
1 August 2023
Cho, Yoosun
18ca53a3-7cda-4567-ac42-88bec4a652e0
Chang, Yoosoo
71f9b27c-a9a0-4014-aaab-52ad46463a4d
Ryu, Seungho
d3702257-53d3-41af-a74a-31de721d1719
Wild, Sarah H.
cdbb4f1e-c4a4-419a-bbd1-d018389de831
Byrne, Christopher D.
1370b997-cead-4229-83a7-53301ed2a43c
Cho, Yoosun, Chang, Yoosoo, Ryu, Seungho, Wild, Sarah H. and Byrne, Christopher D.
(2023)
Synergistic effect of non-alcoholic fatty liver disease and history of gestational diabetes to increase risk of type 2 diabetes.
European Journal of Epidemiology, 38 (8), .
(doi:10.1007/s10654-023-01016-1).
Abstract
Whether non-alcoholic fatty liver disease (NAFLD) improves risk prediction for subsequent type 2 diabetes mellitus (T2DM) in women with prior gestational diabetes mellitus (pGDM) is uncertain. We examined the combined effects of NAFLD and pGDM on risk prediction for incident T2DM. This retrospective cohort study included 97,347 Korean parous women without diabetes mellitus at baseline whose mean (SD) age was 39.0 (7.8) years. Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident T2DM according to self-reported pGDM and ultrasound-diagnosed NAFLD at baseline. When combined with conventional diabetes risk factors, the incremental predictive ability of NAFLD and pGDM to identify incident T2DM was assessed. During a median follow-up of 3.9 years, 1,515 cases of incident T2DM occurred. Multivariable-adjusted HRs (95% confidence intervals [CIs]) for incident T2DM comparing pGDM alone, NAFLD alone, and both NAFLD and pGDM to the reference (neither NAFLD nor pGDM) were 2.61 (2.06–3.31), 2.26 (1.96–2.59), and 6.45 (5.19-8.00), respectively (relative excess risk of interaction = 2.58 [95% CI, 1.21–3.95]). These associations were maintained after adjusting for insulin resistance, body mass index, and other potential confounders as time-dependent covariates. The combination of NAFLD and pGDM improved risk prediction for incident T2DM (based on Harrell’s C−index, also known as the concordance index, and net reclassification improvement) compared to conventional diabetes risk factors. In conclusion, NAFLD synergistically increases the risk of subsequent T2DM in women with pGDM. The combination of NAFLD and pGDM improves risk prediction for T2DM.
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230428 EJEP-D-22-01564__text_clean
- Accepted Manuscript
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230428 EJEP-D-22-01564_table
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230428 Fig1
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Accepted/In Press date: 5 May 2023
e-pub ahead of print date: 31 May 2023
Published date: 1 August 2023
Additional Information:
Funding Information:
We thank our staff members at the Kangbuk Samsung Health Study for their hard work, dedication, and support. This study was supported by the SKKU Excellence in Research Award Research Fund, Sungkyunkwan University (2021), and the National Research Foundation of Korea, funded by the Ministry of Science, ICT, and Future Planning (NRF-2021R1A2C1012626). CDB was supported in part by the Southampton National Institute for Health Research Biomedical Research Centre (NIHR203319), U.K.
Keywords:
cohort study, gestational diabetes mellitus, non-alcoholic fatty liver disease, type 2 diabetes mellitus
Identifiers
Local EPrints ID: 477392
URI: http://eprints.soton.ac.uk/id/eprint/477392
ISSN: 0393-2990
PURE UUID: 206a8efa-a7b0-43d6-999c-ced02453d197
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Date deposited: 05 Jun 2023 17:02
Last modified: 05 May 2024 04:01
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Contributors
Author:
Yoosun Cho
Author:
Yoosoo Chang
Author:
Seungho Ryu
Author:
Sarah H. Wild
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