Influence of non-alcoholic fatty liver disease on the development of diabetes mellitus: results from a prospective, community based, cohort study

Abstract

INTRODUCTION OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is considered the hepatic component of metabolic syndrome, and is strongly associated with diabetes mellitus (DM). There are also suggestions that NAFLD may predict the future development of DM. Aim of this study was to explore whether NAFLD is a risk factor for development of DM in an urban community. METHODS: The Ragama Health Study is conducted in the Ragama MOH area of the Gampaha district. Adults aged 35-64 years were selected from this urban community using stratified random sampling were screened by structured interview, liver ultrasound, biochemical and serologicai tests. Participants and with NAFLD (based on fatty liver on established ultrasound criteria, drinking alcohol within safe limits, HBsAg and anti-HCV negative) and those without NAFLD at baseline (January-September 2007) were prospectively followed up for three years and reassessed. RESULTS: Of 2983 people recruited, 926 (31%) had NAFLD; 2275 did not have DM at baseline [618 in the NAFLD group and 1657 in the non-NAFLD group]. After three years, 257 (11.3%) had developed DM de novo [106 (17.2%) in the NAFLD group vs. 151 (9.1%) in the non-NAFLD group; /=10.01; p^O.002]. On multivariate analysis, NAFLD at baseline was an important predictor of incident DM (OR=1.5; 95% CI: 1.1-2.1) independent of age, sex, baseline BMI, waist circumference, dyslipidaemia and hypertension. Other significant predictors of DM were age, baseline waist circumference and dyslipidaemia.CONCLUSIONS: Our results indicate that those with NAFLD are at an increased risk of developing DM. This has important implications for prevention and management of the diabetes epidemic.