Fatty liver index predicts incident risk of prediabetes, type 2 diabetes and non-alcoholic fatty liver disease (NAFLD)

Daniel J Cuthbertson; Juha Koskinen; Emily Brown; Costan G Magnussen; Nina Hutri-Kähönen; Matthew Sabin; Päivi Tossavainen; Eero Jokinen; Tomi Laitinen; Jorma Viikari; Olli T Raitakari; Markus Juonala

doi:10.1080/07853890.2021.1956685

Fatty liver index predicts incident risk of prediabetes, type 2 diabetes and non-alcoholic fatty liver disease (NAFLD)

Ann Med. 2021 Dec;53(1):1256-1264. doi: 10.1080/07853890.2021.1956685.

Authors

Daniel J Cuthbertson¹, Juha Koskinen^{2

3}, Emily Brown¹, Costan G Magnussen^{2

4}, Nina Hutri-Kähönen⁵, Matthew Sabin⁶, Päivi Tossavainen⁷, Eero Jokinen⁸, Tomi Laitinen⁹, Jorma Viikari^{10

11}, Olli T Raitakari², Markus Juonala^{10

11}

Affiliations

¹ Metabolism and Nutrition Research Group, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
² Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
³ Heart Center, Kotka Central Hospital, Kotka, Finland.
⁴ Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
⁵ Department of Pediatrics, Tampere University and Tampere University Hospital, Tampere, Finland.
⁶ Murdoch Children's Research Institute, The Royal Children's Hospital and University of Melbourne, Melbourne, Australia.
⁷ Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.
⁸ Department of Pediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
⁹ Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland.
¹⁰ Department of Medicine, University of Turku, Turku, Finland.
¹¹ Division of Medicine, Turku University Hospital, Turku, Finland.

Abstract

Aims: To investigate the association between overweight/obesity and fatty liver index (FLI) on the odds of incident prediabetes/type 2 diabetes and non-alcoholic fatty liver disease (NAFLD) in 2020 participants after 10 years follow up.

Methods: At baseline (in 2001) 2020 participants, males and females, aged 24-39 years, were stratified according to body mass index (BMI), normal weight (<25 kg/m²), overweight (≥25-<30 kg/m²), or obese (≥30 kg/m²) and FLI (as high FLI ≥60 or low FLI <60). We examined the incidence of prediabetes/type 2 diabetes and NAFLD (ultrasound assessed) over 10 years to 2011 to determine the relative impact of FLI and BMI.

Results: 514 and 52 individuals developed prediabetes and type 2 diabetes during follow-up. Such individuals were older, with higher BMI, serum glucose, insulin, alanine aminotransferase (ALT) and triglyceride (TG) concentrations than those who did not develop prediabetes or type 2 diabetes (n = 1454). The additional presence of high FLI significantly increased the risk of developing prediabetes and type 2 diabetes above the risk of being overweight/obese. Compared with normal weight, low FLI participants, the odds of prediabetes were ∼2-fold higher and the odds of type 2 diabetes were 9-10-fold higher respectively in the overweight/obese, high FLI group. No difference was observed between normal weight, low FLI and overweight/obese and low FLI groups.

Conclusions: An increased FLI significantly increases the odds of incident prediabetes, type 2 diabetes and NAFLD in individuals with overweight/obese highlighting the contributory role of liver fat accumulation in the pathophysiology of prediabetes/type 2 diabetes.Key messagesObesity is a risk factor for non-alcoholic fatty liver disease (NAFLD), prediabetes and type 2 diabetes.Additionally, NAFLD is more prevalent in people with prediabetes and type 2 diabetes when compared to age- and BMI-matched individuals.The presence of a raised fatty liver index (FLI) confers a significantly increased risk of developing prediabetes, type 2 diabetes and NAFLD above that conferred by being overweight/obese.The degree of elevation of FLI can risk stratify for incident prediabetes and type 2 diabetes in people with obesity.

Keywords: Non-alcoholic fatty liver disease; metabolic syndrome; obesity; risk; type 2 diabetes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Body Mass Index
Diabetes Mellitus, Type 2 / epidemiology*
Female
Finland / epidemiology
Humans
Incidence
Male
Metabolic Syndrome / epidemiology
Non-alcoholic Fatty Liver Disease / diagnostic imaging
Non-alcoholic Fatty Liver Disease / epidemiology*
Obesity / epidemiology
Overweight / epidemiology
Prediabetic State / diagnosis
Prediabetic State / epidemiology*
Risk Factors

Grants and funding

The Young Finns Study has been supported by Academy of Finland grants 126925, 121584, 124282, 129378 (Salve), 117797 (Gendi) and 41071 (Skidi); the Social Insurance Institution of Finland; Kuopio, Tampere and Turku University Hospital Medical Funds [grants 9M048 and 9N035]; the Juho Vainio Foundation; the Paavo Nurmi Foundation; the Finnish Foundation for Cardiovascular Research; the Finnish Cultural Foundation; the Tampere Tuberculosis Foundation; and the Emil Aaltonen Foundation. This work was also funded by the National Health and Medical Research Council [grant APP1098369]. C.G.M is supported by a National Heart Foundation of Australia Future Leader Fellowship [100849]. J.K. was supported by Turku University Foundation, Emil Aaltonen Foundation and Urmas Pekkala Foundation