Background: No data are available on the association between changes in fatty liver disease (FLD) and the risk of type 2 diabetes in elderly individuals with prediabetes. Methods: A total of 156,984 elderly subjects with prediabetes who underwent national health screening in 2009 and 2011 were followed up. FLD was defined as a change in the fatty liver index (FLI) with a cut-off of 60 for steatosis and 30 as a reference. Multivariable Cox proportional hazards regression was used to calculate the hazard ratio (HR) and confidence intervals (CIs) for type 2 diabetes according to the changed status of the FLD. Results: During a median of 8.35 years of follow-up, 29,422 (18.7%) elderly individuals with prediabetes developed type 2 diabetes. Multivariable adjusted HRs of type 2 diabetes according to FLI change were 2.22 (95% CI 2.11-2.34) in individuals with both FLI ≥ 60 compared to those with both FLI < 30. Although weight loss ≥5% was associated with a 7% lower risk of type 2 diabetes (95% CI 0.90-0.96), those with resolved FLD, new FLD, and persistent FLD along with weight loss at the same time period had an increased risk of type 2 diabetes by 30%, 36%, and 53%, respectively. The risk of type 2 diabetes did not increase in individuals with FLD-free status, regardless of weight change. Conclusions: The presence and change of FLD is an important factor for the development of type 2 diabetes in elderly individuals with prediabetes. Disclosure J.Park: None. J.Won: None.

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