Key result
Pre-diabetes in NAFLD linked to ~4.3-fold higher odds of metabolic syndrome, but not CVD events.
Why the study?
Insulin resistance is central to the pathophysiology of diabetes, NAFLD, and atherogenesis leading to cardiovascular disease, but the frequency of pre-diabetes and cardiometabolic risk factors in NAFLD patients remain to be clarified.
Does pre-diabetes increase the risk of metabolic syndrome and cardiovascular disease in patients with NAFLD compared to those with normal glucose tolerance?
Case-Control (n=694)
No
Does pre-diabetes increase the risk of metabolic syndrome and cardiovascular disease in patients with NAFLD compared to those with normal glucose tolerance?
Odds Ratio: 4.31 (95% CI 2.95–6.29)
Absolute Event Rate: 58.2% vs 24.4%
p-value: p=<0.001
Among patients with non-alcoholic fatty liver disease, the presence of pre-diabetes significantly increases the risk of metabolic syndrome but does not appear to independently predict baseline cardiovascular disease when adjusted for age, sex, BMI, and smoking.
Pre-diabetes may flag higher concurrent metabolic syndrome risk in NAFLD; leaves open independent cardiovascular event prediction.
Objectives: Insulin resistance plays a critical role in the pathophysiology of diabetes mellitus and non-alcoholic fatty liver disease (NAFLD). Moreover, insulin resistance has a central role in atherogensis as the major leading cause of cardiovascular disease (CVD). The aim of the present study was to assess the frequency of pre-diabetes and evaluate the cardiometabolic risk factors among NAFLD patients, comparing those with pre-diabetes to those with normal glucose tolerance. Methods: In the current retrospective case-control study, the data of 1031 NAFLD patients was retrieved. Based on blood glucose levels, 337 diabetics, 340 pre-diabetes, and, 354 normal glucose patients were diagnosed. After excluding diabetic NAFLD patients, 694 individuals were divided into two groups: normal glucose and pre-diabetes. Various variables, such as age, anthropometric measurements, hypertension, systolic and diastolic blood pressure, and lipid profiles, were extracted from patient files. Statistical analysis was conducted to assess cardiovascular risk factors in NAFLD patients. Results: Higher age, female gender, higher BMI, triglyceride, waist and hip circumference and waist-to-hip ratio were found in pre-diabetic NAFLD individuals compared with normoglycemic ones (P-value<0.05). Multivariable age-, sex-, BMI- and smoking- adjusted logistic regression showed a predicting role of pre-diabetes and NAFLD concurrence with metabolic syndrome (P-value<0.001, OR:4.31, 95% CI: 2.95- 6.29), but not CVD (P-value=0.353, OR:1.37, 95% CI: 0.71- 2.61). Conclusion: In this study, nearly one-third of NAFLD patients had pre-diabetes. The mean value of age, BMI, TG, waist and Hip circumference was significantly higher in pre-diabetic patients. The concurrence of pre-diabetes and NAFLD was a predicting factor for metabolic syndrome, but not CVD events.
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Teimouri et al. (2025) conducted a case-control in Non-alcoholic fatty liver disease (NAFLD) (n=694). Pre-diabetes vs. Normal glucose tolerance was evaluated on Metabolic syndrome (OR 4.31, 95% CI 2.95-6.29, p=<0.001). Pre-diabetes in patients with NAFLD was independently associated with a more than four-fold increased odds of concurrent metabolic syndrome (OR 4.31) but not significantly associated with cardiovascular disease events.
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