Association of NAFLD With Diabetes and the Impact of BMI Changes: A 5-Year Cohort Study Based on 18,507 Elderly

J Clin Endocrinol Metab. 2017 Apr 1;102(4):1309-1316. doi: 10.1210/jc.2016-3440.


Context: Previous studies about the relationship between nonalcoholic fatty liver disease (NAFLD) and diabetes are limited by inconsistent conclusions, mainly being cross-sectional and having a small sample size, no elderly people, or a lack of prediabetes.

Objective: This study sought to examine the relationship between NAFLD and diabetes and prediabetes in a large cohort based on Chinese male elderly.

Design: This was a retrospective cohort study that was followed up for ∼5 years.

Setting: This study was conducted in Beijing, China.

Participants: Chinese male elderly (n = 18,507). Participants with diabetes/prediabetes at baseline were excluded.

Main outcome measures: Ultrasound was used for diagnosis of NAFLD.

Results: Mean age of the 18,507 participants was 71.38 ± 14.15 years. The prevalence of NAFLD was 18.77% (3474/18,503), and participants with NAFLD had higher body mass index (BMI), blood pressure levels, blood lipid levels, and also higher alanine aminotransferase levels (P < 0.001). The total 5-year incidence was 2.448% for diabetes and 10.628% for prediabetes. Participants with NAFLD at baseline had a higher incidence of both diabetes and prediabetes. The adjusted relative risks (RRs) were 1.672 [95% confidence interval (CI), 1.361 to 2.052] and 1.336 (95% CI, 1.205 to 1.481). The RRs were closely related to BMI changes. The adjusted RRs for diabetes according to three BMI change groups (<-1.00 kg/m2, -1.00 to 1.00 kg/m2, >1.00 kg/m2) were 1.599 (95% CI, 1.054 to 2.426), 1.640 (95% CI, 1.241 to 2.167), and 1.918 (95% CI, 1.239 to 2.969), respectively. Similar results were obtained when prediabetes was used as the dependent variable.

Conclusions: There was a strong and independent association between NAFLD and both diabetes and prediabetes among Chinese male elderly, and this relationship was closely related to BMI changes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Beijing / epidemiology
  • Body Mass Index*
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Non-alcoholic Fatty Liver Disease / complications
  • Non-alcoholic Fatty Liver Disease / epidemiology*
  • Obesity / complications
  • Obesity / epidemiology
  • Overweight / complications
  • Overweight / epidemiology
  • Prediabetic State / complications
  • Prediabetic State / epidemiology
  • Prevalence
  • Retrospective Studies