Bidirectional association between nonalcoholic fatty liver disease and type 2 diabetes in Chinese population: Evidence from the Dongfeng-Tongji cohort study

PLoS One. 2017 Mar 28;12(3):e0174291. doi: 10.1371/journal.pone.0174291. eCollection 2017.


Objectives: The aim of this study is to examine the bidirectional association between nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM).

Methods: The data was derived from the Dongfeng-Tongji cohort study, which was established in 2008 and followed until October 2013. NAFLD was classified as none, mild, moderate/severe based on ultrasound examination. The analysis to examine the association between NAFLD and incident T2DM risk included 18,111 participants free of diabetes at baseline and the duration of follow-up was 4.60 ± 0.60 years. Cox proportional regression model was used to calculate the hazard ratio (HR) for the association. The analysis to investigate the association between T2DM and incident NAFLD risk included 12,435 participants free of NAFLD at baseline. Logistic regression model was used to calculate the odd ratio (OR) of NAFLD.

Results: Compared with those without NAFLD, individuals with mild or moderate/severe NAFLD had a monotonic elevated risk of developing T2DM (HR: 1.88 [95% CI: 1.63-2.18] and 2.34 [1.85-2.96], respectively) after adjustment for potential confounders. In a parallel analysis, compared to participants with fasting plasma glucose < 6.1 mmol/L, the ORs of developing NAFLD in subjects with impaired fasting glucose and T2DM were 1.35 (95% CI: 1.16-1.57) and 1.40 (95% CI: 1.22-1.62), respectively.

Conclusions: Our results provide compelling evidence that the NAFLD-T2DM association is bidirectional in Chinese population.

MeSH terms

  • Aged
  • Blood Glucose / analysis
  • China / epidemiology
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / etiology*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Non-alcoholic Fatty Liver Disease / blood
  • Non-alcoholic Fatty Liver Disease / complications*
  • Non-alcoholic Fatty Liver Disease / etiology*
  • Proportional Hazards Models


  • Blood Glucose

Grant support

This work was supported by the grant from the National Natural Science Foundation (grant NSFC-81522040, 81473051, and 81230069); the 111 Project (No. B12004); the Program for Changjiang Scholars; Innovative Research Team in University of Ministry of Education of China (No. IRT1246); China Medical Board (No. 12-113) and the Program for the New Century Excellent Talents in University (NCET-11-0169) for Meian He.