Impacto del hígado graso no alcohólico en la incidencia de diabetes tipo 2estudio de una cohorte de trabajadores con prediabetes

Abstract

Introduction: Non-alcoholic fatty liver disease (NAFLD) is defined as the accumulation of fatty deposits in the hepatocytes, not related to significant alcohol intake. Its prevalence is between 25% – 30% in adult population and 69% in patients with type 2 diabetes (T2D). NAFLD and DM2 are conditions that frequently coexist and can act synergistically, leading to cardiovascular events. Prediabetes is considered the main risk factor for the development of T2D, whereas few studies have evaluated the relationship between NAFLD and prediabetes. The main aim of the present doctoral thesis is to investigate the relationship between NAFLD and T2D, as well as the sociodemographic, clinical, metabolic and lifestyle risk factors in a working adults population with prediabetes. Methods: The study population includes a cohort of working adults employed in the service sector, who underwent routine occupational health visits between January 2012 and December 2018. A total of 27,844 workers were selected according to the following inclusion criteria: age between 20 and 65 years, fasting plasma glucose (FPG) between 100 and 125 mg/dl, having agreed to participate in the study and signed the informed consent. Subjects with a diagnosis of diabetes, in treatment with oral antidiabetics or systemic glucocorticoids, with an FPG 126 mg/dL, or a glycated hemoglobin (HbA1c) 6.5% at baseline were excluded from the analyses. Sociodemographic characteristics, anthropometric data, clinical parameters, and lifestyle data were collected. The incidence of T2D, defined as FPG ≥126 mg/dL or initiation of pharmacological treatment with oral antidiabetic drugs, was evaluated at 5 years follow-up. Results: The prevalence of NAFLD defined by fatty liver index (FLI) (FLI ≥60) was 19.1% (95% CI 18.7% – 19.5%) overall, 27.9% (95% CI 23.3% – 28.5%) for men and 6.8% (95% CI 6.4% – 7.3%) for women and increased across age intervals. Men presented worse cardiometabolic and anthropometric profiles than women. NAFLD was strongly associated with older age, HDL-cholesterol, less advantaged social class, prediabetes, prehypertension, hypertension, and smoking in both sexes, although the association between hypertension and NAFLD was higher in women than in men (OR 4.01 [95% CI 3.38 – 4.75] vs. 2.85 [95% CI 2.64 – 3.09]; p<0.001). At 5-year follow-up, 36% of workers with prediabetes reverted to normoglycemia, 41% persisted in the prediabetic state and 23% progressed to T2D. The risk of developing T2D increased with age, body mass index (BMI), triglyceride levels, and lack of physical activity (PA). The 5-year incidence rates of T2D were highest for individuals with FLI ≥60, at 56.7%, whereas for individuals with FLI 30-60 and FLI <30 the incidence rates were of 7.8% and 0.3%, respectively. In addition, 33.7% of subjects reverted to normoglycemia at the 5-year follow-up. The adjusted logistic regression model showed that FLI <30, engaging in regular PA, and consuming fruits and vegetables daily were independently associated with reversion to normoglycemia. FLI was found to be the best predictor of reversion. Conclusions: One in 4 individuals with prediabetes will progress to T2D within at 5 years of follow-up. FLI is an effective and practical method to stratify the risk of progression to T2D based on the degree of hepatic steatosis. BMI control and regular PA practice could prevent progression to T2D.