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Topical Area: Nutritional Epidemiology

Nutritional Epidemiology (II) (Poster Session)

(P29-053-23) Association Between Diabetes and Liver Disease Progression in Non-Alcoholic Fatty Liver Disease Patients

Monday, July 24, 2023
12:45 PM – 1:45 PM ET
Location: Poster Board 178

    Presenting Author(s)

  • Xinyuan Zhang, PhD

    Postdoctoral Fellow
    Brigham and Women's Hospital and Harvard Medical School
    Boston, Massachusetts, United States

    • Co-Author(s)

  • Longgang Zhao, MBBS, MSc

    PhD candidate
    University of South Carolina
    Boston, Massachusetts, United States

  • TH

    Tao Hou

    Harvard T.H. Chan School of Public Health

  • ML

    Michelle Lai, PhD

    Beth Israel Deaconess Medical Center
    Boston, Massachusetts, United States

  • XZ

    Xuehong Zhang, MD, ScD

    Brigham and Women’s Hospital and Harvard Medical School
    Boston, Massachusetts, United States

Disclosure(s):
Xinyuan Zhang, PhD: No relevant financial relationship(s) with ineligible companies to disclose.
Longgang Zhao, MBBS, MSc: No relevant financial relationship(s) with ineligible companies to disclose.


Objectives: Type 2 diabetes (T2D) has been linked to non-alcoholic fatty liver disease (NAFLD). However, a limited amount of prospective data on the progression of NAFLD exists, and the association between T2D and advanced liver outcomes in people with NAFLD has not been quantified.

Methods: We developed an electronic health record data-based cohort of patients with NAFLD (International Classification of Diseases (ICD)-9: 571.8; ICD-10: K76.0, K75.8) from the Mass General Brigham Biobank. Baseline blood glucose and glycated hemoglobin (HbA1C) were assessed at the first NAFLD diagnosis and categorized into quintile categories. T2D was defined as having either (1) blood glucose ≥126 mg/dL, (2) HbA1C ≥6.5%, (3) anti-diabetic medication (e.g., metformin, insulin), or (4) previous T2D diagnosis (ICD-9: 250; ICD-10: E11.9). We used Cox regression models to generate hazard ratios (HRs) with 95% confidence intervals (CIs) for developing incident liver cirrhosis, cirrhosis-related complications (e.g., ascites, portal hypertension), and liver cancer. We adjusted for covariates including age, sex, race, ethnicity, smoking status, alcohol intake, body mass index, alanine transaminase, and hepatitis B and C virus infection.

Results: In 7,456 NAFLD patients, 3,418 had T2D at baseline. During a median of 5.3 years of follow-up, 186 developed liver cirrhosis, 345 developed ascites, 51 developed portal hypertension, and 67 developed liver cancer. Higher blood glucose was associated with a higher risk of ascites (HRQ5 VS. Q1 = 2.81; 95% CI: 1.95, 4.05; p-trend < 0.001), portal hypertension (HRQ5 VS. Q1 = 2.87; 95% CI: 1.02, 8.09; p-trend = 0.02) and liver cancer (HRQ5 VS. Q1 = 8.76; 95% CI: 2.04, 37.6; p-trend = 0.02). Having a metformin or insulin prescription was associated with a higher risk of cirrhosis, ascites, and liver cancer (all p < 0.05). T2D was associated with a higher risk of liver cirrhosis (HR = 1.38; 95% CI: 1.02, 1.87) and ascites (HR = 2.08; 95% CI: 1.67, 2.59). The associations remained robust after excluding incident cases within the first year after NAFLD diagnosis.

Conclusions: In a large prospective cohort of people with NAFLD, T2D was associated with an increased risk of progressing into advanced liver outcomes. This result indicates a probable favorable impact of controlling diabetes in patients with NAFLD.

Funding Sources: None