Clinical availability of nonalcoholic fatty liver disease as an early predictor of type 2 diabetes mellitus in Korean men: 5-year prospective cohort study

Hepatology. 2013 Apr;57(4):1378-83. doi: 10.1002/hep.26183.


There have been several reports about the clinical association between type 2 diabetes mellitus (DM) and nonalcoholic fatty liver disease (NAFLD). However, most of the studies were about the unilateral effects of type 2 DM on NAFLD, and studies on the reverse relation are rare. Thus, this study was designed to investigate the effect of NAFLD on type 2 DM. We conducted a prospective cohort study on 25,232 Korean men without type 2 DM for 5 years. We serially checked the various metabolic factors including fasting glucose and hemoglobin A1c (HbA1c), and monitored the development of type 2 DM. The incidence rate of type 2 DM was compared according to the degree of NAFLD (normal, mild, and moderate to severe), and a Cox proportional hazards model was used to measure the hazard ratios (HRs) of NAFLD on type 2 DM. The incidence rate of type 2 DM increased according to the degree of NAFLD (normal: 7.0%, mild: 9.8%, moderate to severe: 17.8%, P < 0.001). Even after adjusting for other multiple covariates, the HRs (95% confidence interval [CI]) for type 2 DM development was higher in the mild group (1.09; 0.81-1.48) and moderate to severe group (1.73; 1.00-3.01) compared to the normal group, respectively (P for trend <0.001).

Conclusion: The development of type 2 DM is potentially more associated with more progressive NAFLD than a normal or milder state. In addition, NAFLD was an independent risk factor for the future development of type 2 DM. These results suggest the potential availability of NAFLD as an early predictor of type 2 DM.

MeSH terms

  • Adult
  • Blood Glucose / metabolism
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Diabetes Mellitus, Type 2 / ethnology*
  • Fatty Liver / blood
  • Fatty Liver / complications*
  • Fatty Liver / ethnology*
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Incidence
  • Liver / diagnostic imaging
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Non-alcoholic Fatty Liver Disease
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Prospective Studies
  • Republic of Korea / epidemiology
  • Risk Factors
  • Severity of Illness Index*
  • Ultrasonography


  • Blood Glucose
  • Glycated Hemoglobin A