Patients with non-alcoholic fatty-liver disease (NAFLD) have a higher risk of diabetes, and the more severe the disease the greater the risk, according to new research. "This updated and large meta-analysis provides clear evidence that NAFLD is associated with an approximate doubled risk of developing type 2 diabetes mellitus, irrespective of obesity and other metabolic risk factors," said Dr. Giovanni Targher of the University of Verona, in Italy. "The magnitude of this risk parallels the severity of NAFLD, such that patients with more advanced stages of liver fibrosis are at greater risk of developing type 2 diabetes," he told Reuters Health by email. Dr. Targher and colleagues analyzed 33 observational studies covering of the link between NAFLD and risk of incident diabetes. Most (27) were conducted in Asia, two were from the U.S. and the remainder were European. More than half a million participants, of whom 154,314 (31%) had imaging-defined or biopsy-proven NAFLD at baseline, were followed for a median of five years, during which time 27,953 developed type-2 diabetes. Data from 26 studies showed that patients with NAFLD had a significantly higher risk of incident diabetes than those without the condition. Based on a random-effects model, their hazard ratio was 2.19 (95% confidence interval, 1.93 to 2.48), the researchers report in Gut. Patients with severe NAFLD saw a greater risk increase (HR, 2.69; 95% CI, 2.08 to 3.49; nine studies). Based on five studies, this risk markedly increased across the severity of liver fibrosis (HR, 3.42; 95% CI, 2.29 to 5.11). "Although further research is needed to draw a definitive conclusion," said Dr. Targher, "the findings of this large meta-analysis has important implications for decision making in public health and clinical practice, and highlights the urgency of developing effective treatments for NAFLD that also ameliorate the risk of extra-hepatic comorbidities and complications of NAFLD, such as type-2 diabetes mellitus." Gastroenterologist and hepatologist Dr. Na Li of Ohio State University, in Columbus, who was not involved in the study, told Reuters Health by email, "Clinically it's not always easy to define the relationship between diabetes and NAFLD due to shared pathogenesis and risk factors." "This meta-analysis not only demonstrated an increased risk of developing diabetes in patients with NAFLD but also revealed an association of such risk with the severity of NAFLD. Based on these findings, it's important for clinicians to monitor their patients with NAFLD for diabetes," she added. —David Douglas Source
