Nonalcoholic fatty liver disease as a sentinel marker for the development of diabetes mellitus in non-obese subjects

Background: Non alcoholic fatty liver disease (NAFLD) is associated with substantial cardiometabolic morbidity. Aims: We evaluated the long-term extrahepatic complications of NAFLD and sought to evaluate NAFLD in non-obese subjects. Methods: A total of 2920 participants were retrospectively selected from a health check-up center in 2000, and followed through to December 2010. NAFLD was diagnosed using ultrasonography. Subjects were stratified according to body mass index, NAFLD, and metabolic syndrome. Results: The prevalence of non-obese NAFLD subjects and metabolically unhealthy non-obese subjects was 14.4% and 8.7%, respectively. In the multivariate analysis, non-obese NAFLD subjects had a significantly higher risk for diabetes mellitus (DM; HR 2.69, 95% CI 1.72-4.20, P < 0.001); no increase was observed for hypertension or cardiovascular disease. Metabolically unhealthy non-obese subjects had a significantly higher risk for hypertension (HR 2.75, 95% CI 2.02-3.74, P<0.001), DM (HR 5.72, 95% CI 3.68-8.89, P<0.001), and cardiovascular disease (HR 2.93, 95% CI 1.53-5.63,P = 0.001). Subgroup analysis of non-obese subjects showed that NAFLD, without metabolic syndrome, conferred a higher risk for DM (HR 3.60, 95% CI 2.03-6.39, P<0.001). Conclusion: Non-obese subjects with NAFLD are at a higher risk for DM independent of metabolic syndrome. (C) 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.