Non-alcoholic fatty liver disease as risk factor for the development of diabetes and metabolic syndrome
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Chronic hyperinsulinaemia is associated with insulin resistance and metabolic syndrome. It is also directly involved in liver lipogenesis, leading to non-alcoholic fatty liver (NAFL) infiltration or disease (NAFLD). The latter’s commonest presentation is non-alcoholic steatohepatitis (NASH), which is increasingly seen as a comorbidity of the metabolic syndrome phenotype. As the impact of NAFLD on the development of metabolic complications is still unclear, the study aimed to determine whether NAFLD with elevated aminotransaminase (ALT) levels was a risk factor for incident diabetes or metabolic syndrome. NAFLD was diagnosed on the basis of raised ALT (>40 IU/L) after excluding alcohol, viral, metabolic, and autoimmune liver disease. A total of 109 subjects with NAFLD and 249 without at baseline attended follow-up after 11.1 years. After excluding subjects with diabetes at baseline, those with NAFLD were significantly more likely to develop incident diabetes during follow-up. After excluding subjects with metabolic syndrome at baseline, those with NAFLD were significantly more likely to develop incident metabolic syndrome during follow-up. However, after adjusting for baseline waist circumference, hypertension, and insulin resistance, NAFLD was no longer a significant independent predictor for incident diabetes or metabolic syndrome. In conclusion, subjects with NAFLD and elevated ALT are at increased risk of developing diabetes and metabolic syndrome, in association with known metabolic cardiovascular risk factors.
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