The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Indices of hepatic steatosis and fibrosis in prediabetes and association with diabetes development in the vitamin D and type 2 diabetes study
1AdventHealth Translational Research Institute, Orlando, FL, United States of America. Electronic address: D2d@tuftsmedicalcenter.org.
2Tufts Medical Center, Boston, MA, United States of America.
3The University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha, NE, United States of America.
4University of Kansas Medical Center, Kansas City, KS, United States of America.
5Research Unit of Biomedicine and Internal Medicine, Faculty of Medicine, and Medical Research Center, University of Oulu and Oulu University Hospital, 90220 Oulu, Finland; Department of Pediatric Gastroenterology and Metabolic Diseases, Pediatric Institute, Poznan University of Medical Sciences, 60-572 Poznan, Poland.
6Weill Cornell Medicine, New York, NY, United States of America.
7Stanford University Medical Center, Stanford, CA, United States of America.
8The University of Colorado School of Medicine, Aurora, CO, United States of America; The Veterans Affairs Eastern Colorado Health Care System, Aurora, CO, United States of America.
9National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, United States of America.
Abstract
Aims: Non-alcoholic fatty liver disease (NAFLD) is a common comorbidity that leads to poor outcomes in people at high risk for development of type 2 diabetes (T2D). Vitamin D is a possible mediator. In the vitamin D and type 2 diabetes study (D2d), we investigated the relationship of baseline indices of NAFLD with incident T2D and whether the effect of vitamin D on diabetes was modified by NAFLD.
Methods: Cross-sectional associations of indices of NAFLD with glycemia and vitamin D status were assessed in 3972 individuals screened for the D2d study. In those with prediabetes randomized to vitamin D or placebo (n = 2423), we examined longitudinal associations of NAFLD indices with incident T2D. We used validated non-invasive scores to assess steatosis [(hepatic steatosis index (HSI); NAFLD-liver fat score (NAFLD-LFS)] and advanced fibrosis [fibrosis-4 (FIB-4) index; AST to Platelet Ratio Index (APRI)].
Results: Eighty-five percent of screened participants had likely steatosis by HSI and 71 % by NAFLD-LFS; 3 % were likely to have advanced fibrosis by FIB-4 and 1.2 % by APRI. FIB-4 indicated that 20.4 % of individuals require further follow up to assess liver health. Steatosis and fibrosis scores were higher among participants with worse glycemia. The NAFLD-LFS and APRI predicted development of diabetes (hazard ratios [95%CI] 1.35 [1.07, 1.70]; P = 0.012) and 2.36 (1.23, 4.54; P = 0.010), respectively). The effect of vitamin D on diabetes risk was not modified by baseline NAFLD indices. Individuals with likely steatosis had a smaller increase in serum 25-hydroxyvitamin D level in response to vitamin D than those without steatosis.
Conclusions: The predicted high prevalence of steatosis, the need for further fibrosis workup, and the relationship between liver health and incident T2D suggest that routine screening with clinically accessible scores may be an important strategy to reduce disease burden.