Association of non-alcoholic fatty liver disease with cardiovascular disease and all cause death in patients with type 2 diabetes mellitus: nationwide population based study
Authors' conclusion
NAFLD in patients with T2DM seems to be associated with a higher risk of cardiovascular disease and all cause death, even in patients with mild NAFLD. Risk differences for cardiovascular disease and all cause death between the no NAFLD group and the grade 1 or grade 2 NAFLD groups were higher in patients with T2DM than in those without T2DM.
Study context
- Population
- Participants in the Korean National Health Screening Programme in 2009, with and without T2DM505,763 with T2DM
- Participants
- 7,796,763 participants
- Exposure
- Grade 1 and grade 2 non-alcoholic fatty liver disease (NAFLD) vs no NAFLD, in patients with and without T2DM
- Outcome
- Incident CVD (MI, ischaemic stroke) or all cause death
- Follow-up
- Median 8.13 years
Methodological detailslongitudinal
- Longitudinal
Main finding
As reported in the abstract
5 years
| Group | CVD | All cause death |
|---|---|---|
| No NAFLD, without T2DM | 1.03 (95% CI 1.02 to 1.04) | 1.25 (1.24 to 1.26) |
| Grade 1 NAFLD, without T2DM | 1.23 (1.22 to 1.25) | 1.50 (1.48 to 1.51) |
| Grade 2 NAFLD, without T2DM | 1.42 (1.40 to 1.45) | 2.09 (2.06 to 2.12) |
| No NAFLD, with T2DM | 3.34 (3.27 to 3.41) | 3.68 (3.61 to 3.74) |
| Grade 1 NAFLD, with T2DM | 3.94 (3.87 to 4.02) | 4.25 (4.18 to 4.33) |
| Grade 2 NAFLD, with T2DM | 4.66 (4.54 to 4.78) | 5.91 (5.78 to 6.05) |
CVD
No NAFLD, without T2DM1.03 (95% CI 1.02 to 1.04)
Grade 1 NAFLD, without T2DM1.23 (1.22 to 1.25)
Grade 2 NAFLD, without T2DM1.42 (1.40 to 1.45)
No NAFLD, with T2DM3.34 (3.27 to 3.41)
Grade 1 NAFLD, with T2DM3.94 (3.87 to 4.02)
Grade 2 NAFLD, with T2DM4.66 (4.54 to 4.78)
All cause death
No NAFLD, without T2DM1.25 (1.24 to 1.26)
Grade 1 NAFLD, without T2DM1.50 (1.48 to 1.51)
Grade 2 NAFLD, without T2DM2.09 (2.06 to 2.12)
No NAFLD, with T2DM3.68 (3.61 to 3.74)
Grade 1 NAFLD, with T2DM4.25 (4.18 to 4.33)
Grade 2 NAFLD, with T2DM5.91 (5.78 to 6.05)
Observational data: associations, not effects.
Further findings
NAFLD prevalence by T2DM status
Grade 1 NAFLD
Grade 2 NAFLD
- NAFLD prevalence by T2DM status: 6.49% of participants had T2DM
Incidence rate (per 1000 person years) of CVD and all cause death
- Increased in the order no NAFLD, grade 1, grade 2 NAFLD; higher with T2DM than without
Original publication
Association of non-alcoholic fatty liver disease with cardiovascular disease and all cause death in patients with type 2 diabetes mellitus: nationwide population based study. BMJ. Published 13 February 2024. doi:10.
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