Association between fasting plasma glucose and nonalcoholic fatty liver disease in a nonobese Chinese population with normal blood lipid levels: a prospective cohort study

Abstract

Background: Fasting plasma glucose (FPG) is an easily quantifiable and inexpensive metabolic marker, which is often used to assess cardiovascular disease and diabetes. However, there have been limited studies on the association between FPG and nonalcoholic fatty liver disease (NAFLD) risk in nonobese people, especially in Chinese individuals. The purpose of this study was to investigate the association between FPG and NAFLD in nonobese Chinese people with normal blood lipid levels. Methods: In this prospective cohort study, 9767 nonobese participants with normal blood lipid levels without NAFLD were recruited and prospectively followed for 5 years. The Cox proportional hazard model was used to evaluate the risk factors of NAFLD. Moreover, a Cox model with cubic spline functions and smooth curve fitting (the cubic spline smoothing) were used to identify the nonlinear association between FPG and NAFLD. Results: During the 5-year follow-up, 841 (8.61%) participants were diagnosed with NAFLD. The good functional results (without NAFLD) estimated by the Kaplan-Meier method for 1 year, 2 years, 3 years, 4 years, and 5 years were 98.84, 95.35, 91.67%, 87.57 and 74.86%, respectively. Additionally, through the Cox proportional hazard model, after adjusting for other covariates, there was an independent positive correlation between FPG and increased NAFLD risk (HR:1.21, 95% CI:1.15-1.28, P < 0.0001), and the NAFLD risk was incrementally higher with the rising FPG quartile. The nonlinear association between FPG and NAFLD was visualized by cubic spline smoothing technique. It was calculated that the inflection point of FPG was 5.54. When FPG ≤ 5.54, there was a positive correlation between FPG and the risk of NAFLD (HR:2.20, 95% CI:1.78-2.73, P < 0.0001). When FPG > 5.54, the risk of NAFLD increased by 50% (HR:1.10, 95% CI:1.02-1.18, P = 0.0159) compared with the left side of the inflection point and gradually leveled off.

Waist-to-height ratio and non-alcoholic fatty liver disease in adults

“…Additionally, although the prevalence of NAFLD in non-obese people (BMI < 24 kg/m 2 ) was lower than that in overweight or obese people (BMI ≥ 24 kg/m 2 ), the subgroup analysis showed that the risk of NAFLD in non-obese people was significantly higher than that in overweight or obese people (adjusted OR: 2.73 vs 1.94, P interaction < 0.01). In some recent studies, researchers have expressed similar concerns, believing that non-obese individuals in Asia are vulnerable to NAFLD and the health problems of this unique population should be given attention [ 2 , 18 , 27 , 28 ].…”

“…Values were expressed as mean ± SD or n (%) NAFLD nonalcoholic fatty liver disease, BMI body mass index, WC waist circumference, ALT alanine aminotransferase, AST aspartate aminotransferase, GGT gammaglutamyl transferase, HDL-C high-density lipoprotein cholesterol, TC total cholesterol, TG triglyceride, HbA1c hemoglobin A1c, FPG fasting plasma glucose, SBP systolic blood pressure, DBP Diastolic blood pressure Compared with other studies on the association between WHtR and NAFLD [18,19,[28][29][30], the main advantage of this study was based on the large sample data, further analysis of various potential confounding factors to perform strict statistical adjustment, revealing the positive association between WHtR and NAFLD, and examining the possible unique population through hierarchical analysis and interactive tests. Additionally, our analysis showed a non-linear relationship between WHtR and NAFLD.…”

Association between the alanine aminotransferase/aspartate aminotransferase ratio and new-onset non-alcoholic fatty liver disease in a nonobese Chinese population: a population-based longitudinal study

“…There has long been a consensus among most people regarding the correlation of obesity with NAFLD risk, but data regarding the risk of NAFLD in nonobese people are limited. In previous studies, researchers found that NAFLD in nonobese people was independently correlated with risk factors such as age, height, BMI, TG, TC, LDL-C, UA, GGT, ALT, AST, DBIL, and blood glucose metabolism [ 26 , 40 , 41 ]. In this study, through the follow-up of 12,127 nonobese participants with no NAFLD at baseline, it was proved that the ALT/AST ratio was an independent risk factor for new-onset NAFLD in nonobese people and that the NAFLD risk increased as the ALT/AST ratio gradually increased ( P for trend< 0.001).…”

LDL/HDL cholesterol ratio is associated with new-onset NAFLD in Chinese non-obese people with normal lipids: a 5-year longitudinal cohort study

“…However, in recent years, many studies have pointed out that non-obese people are also prone to NAFLD [12,13]. In previous reports, the prevalence of NAFLD among nonobese people in China was 8.61% [14], and similar results (7.4%) were reported in the United States [15]. Additionally, several recent large cohort studies have shown that compared to obese NAFLD patients, nonobese NAFLD patients are at significantly increased risk for metabolic syndrome and hypertension [16,17], making early detection and intervention of risk factors in non-obese NAFLD patients extremely important.…”