Association between nonalcoholic fatty liver disease and incident diabetes mellitus among Japanese: a retrospective cohort study using propensity score matching

Therapeutic potential of Lactobacillus casei and Chlorella vulgaris in high-fat diet-induced non-alcoholic fatty liver disease (NAFLD)-associated kidney damages: a stereological study

BACKGROUND

The non-alcoholic fatty liver disease (NAFLD) is prevalent in as many as 25% of adults who are afflicted with metabolic syndrome. Oxidative stress plays a significant role in the pathophysiology of hepatic and renal injury associated with NAFLD. Therefore, probiotics such as Lactobacillus casei (LBC) and the microalga Chlorella vulgaris (CV) may be beneficial in alleviating kidney injury related to NAFLD.

MATERIALS AND METHODS

This animal study utilized 30 C57BL/6 mice, which were evenly distributed into five groups: the control group, the NAFLD group, the NAFLD + CV group, the NAFLD + LBC group, and the NAFLD + CV + LBC group. A high-fat diet (HFD) was administered to induce NAFLD for six weeks. The treatments with CV and LBC were continued for an additional 35 days. Biochemical parameters, total antioxidant capacity (TAC), and the expression of kidney damage marker genes (KIM 1 and NGAL) in serum and kidney tissue were determined, respectively. A stereological analysis was conducted to observe the structural changes in kidney tissues.

RESULTS

A liver histopathological examination confirmed the successful induction of NAFLD. Biochemical investigations revealed that the NAFLD group exhibited increased ALT and AST levels, significantly reduced in the therapy groups (p < 0.001). The gene expression levels of KIM-1 and NGAL were elevated in NAFLD but were significantly reduced by CV and LBC therapies (p < 0.001). Stereological examinations revealed reduced kidney size, volume, and tissue composition in the NAFLD group, with significant improvements observed in the treated groups (p < 0.001).

CONCLUSION

This study highlights the potential therapeutic efficacy of C. vulgaris and L. casei in mitigating kidney damage caused by NAFLD. These findings provide valuable insights for developing novel treatment approaches for managing NAFLD and its associated complications.

Non-linear relationship between pulse pressure and the risk of pre-diabetes: a secondary retrospective Chinese cohort study

OBJECTIVE

Previous research has shown that pulse pressure (PP) has a significant role in the start and development of type 2 diabetes mellitus. However, there is little proof that PP and pre-diabetes mellitus (Pre-DM) are related. Our study aimed to investigate the relationship between PP and incident pre-DM in a substantial cohort of Chinese participants.

DESIGN

The 'DATADRYAD' database (www.Datadryad.org) was used to retrieve the data for this secondary retrospective cohort analysis.

PARTICIPANTS

Data from 182 672 Chinese individuals who participated in the medical examination programme were recorded in this retrospective cohort study between 2010 and 2016 across 32 sites and 11 cities in China.

SETTING

PP assessed at baseline and incident pre-DM during follow-up were the target-independent and dependent variables. The association between PP and pre-DM was investigated using Cox proportional hazards regression.

PRIMARY OUTCOME MEASURES

The outcome was incident pre-DM. Impaired fasting glucose levels (fasting blood glucose between 5.6 and 6.9 mmol/L) were used to define pre-DM.

RESULTS

After controlling for confounding variables, PP was positively correlated with incident pre-DM among Chinese adults (HR 1.009, 95% CI 1.007 to 1.010). Additionally, at a PP inflection point of 29 mm Hg, a non-linear connection between the PP and incident pre-DM was discovered. Increased PP was an independent risk factor for developing pre-DM when PP was greater than 29 mm Hg. However, their association was not significant when PP was less than 29 mm Hg. According to subgroup analyses, females, never-smokers and non-obesity correlated more significantly with PP and pre-DM.

CONCLUSION

We discovered that higher PP independently correlated with pre-DM risk in this study of Chinese participants. The connection between PP and incident pre-DM was also non-linear. High PP levels were related to a higher risk of pre-DM when PP was above 29 mm Hg.

ARTICLE FOCUS

Our study investigated the relationship between PP and incident pre-DM in a secondary retrospective cohort of Chinese participants.

Global epidemiology of type 2 diabetes in patients with NAFLD or MAFLD: a systematic review and meta-analysis

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) and metabolic-associated fatty liver disease (MAFLD) shares common pathophysiological mechanisms with type 2 diabetes, making them significant risk factors for type 2 diabetes. The present study aimed to assess the epidemiological feature of type 2 diabetes in patients with NAFLD or MAFLD at global levels.

METHODS

Published studies were searched for terms that included type 2 diabetes, and NAFLD or MAFLD using PubMed, EMBASE, MEDLINE, and Web of Science databases from their inception to December 2022. The pooled global and regional prevalence and incidence density of type 2 diabetes in patients with NAFLD or MAFLD were evaluated using random-effects meta-analysis. Potential sources of heterogeneity were investigated using stratified meta-analysis and meta-regression.

RESULTS

A total of 395 studies (6,878,568 participants with NAFLD; 1,172,637 participants with MAFLD) from 40 countries or areas were included in the meta-analysis. The pooled prevalence of type 2 diabetes among NAFLD or MAFLD patients was 28.3% (95% confidence interval 25.2-31.6%) and 26.2% (23.9-28.6%) globally. The incidence density of type 2 diabetes in NAFLD or MAFLD patients was 24.6 per 1000-person year (20.7 to 29.2) and 26.9 per 1000-person year (7.3 to 44.4), respectively.

CONCLUSIONS

The present study describes the global prevalence and incidence of type 2 diabetes in patients with NAFLD or MAFLD. The study findings serve as a valuable resource to assess the global clinical and economic impact of type 2 diabetes in patients with NAFLD or MAFLD.

The nonlinear correlation between alanine aminotransferase to high-density lipoprotein cholesterol ratio and the risk of diabetes: a historical Japanese cohort study

BACKGROUND

Low levels of high-density lipoprotein cholesterol (HDL-C) and high levels of alanine aminotransferase (ALT) are related to insulin resistance, metabolic syndrome, and diabetes mellitus (DM). However, evidence on the connection between the alanine aminotransferase to high-density lipoprotein cholesterol (ALT/HDL-C) ratio and diabetes mellitus (DM) risk was limited. The study aimed to investigate the relationship between baseline ALT/HDL-C ratio and DM among Japanese individuals.

METHODS

This second analysis was based on a cohort study using open-source data. Data from 15,342 individuals who participated in the medical examination program were recorded at Murakami Memorial Hospital in Japan between 2004 and 2015. Smooth curve fitting, subgroup analysis, Cox proportional-hazards regression, and a series of sensitivity analyses were conducted to examine the relationship between ALT/HDL-C ratio and incident diabetes. The ability of the ALT/HDL-C ratio to predict diabetes was evaluated using a receiver operating characteristic curve analysis.

RESULTS

After controlling for confounding covariates, the ALT/HDL-C ratio was found to be positively correlated to the DM risk in Japanese adults (HR: 1.01, 95%CI: 1.00-1.02, P = 0.049). This study also found a stable relationship between ALT/HDL-C ratio and diabetes after employing a series of sensitivity analyses. Additionally, there was a non-linear association between the ALT/HDL-C ratio and incident diabetes, and the ALT/HDL-C ratio inflection point was 30.12. When the ALT/HDL-C ratio was below 30.12, the present study discovered a significant positive association between the ALT/HDL-C ratio and incident diabetes (HR: 1.04, 95%CI: 1.02-1.06, P = 0.001). Furthermore, among liver enzymes, blood lipids, and anthropometric indicators, the ALT/HDL-C ratio best predicts DM (AUC = 0.75, 95%CI: 0.73-0.78).

CONCLUSION

Increased ALT/HDL-C ratio levels at baseline correlated to incident DM. The relationship between ALT/HDL-C ratio and incident DM was also non-linear. When the ALT/HDL-C ratio is below 30.12, there is a statistically significant positive correlation between the ALT/HDL-C ratio and incident DM.

Lean Nonalcoholic Fatty Liver Disease and Risk of Incident Type 2 Diabetes mellitus: A Literature Review and Meta-analysis

OBJECTIVE

There is limited data regarding the risk of incident type 2 diabetes mellitus(T2DM) among lean nonalcoholic fatty liver disease (NAFLD) individuals. We performed a meta-analysis of relevant studies. Research design and methods We collected data using PubMed, Scopus, Cochrane and Web of Science from the databases' inception until December 2022. We included cohort studies in which lean NAFLD was diagnosed through imaging methods or biopsy. Eligible studies were selected according to predefined keywords and clinical outcomes.

RESULTS

A total of 16 observational studies with 304,975 adult individuals (7.7% with lean NAFLD) and nearly 1300 cases of incident diabetes followed up over a median period of 5.05 years were included in the final analysis. Patients with lean NAFLD had a greater risk of incident diabetes than those without NAFLD (random-effects hazard ratio [HR] 2.72, 95% CI 1.56-4.74; I2 = 93.8%). Compared with the lean without NAFLD group, the adjusted HRs (95% CIs) of incident diabetes for participants in the overweight/obese without NAFLD and overweight/obese with NAFLD groups were 1.32 (0.99- 1.77) and 2.98(1.66-5.32). It appeared to be even greater among NAFLD patients with advanced high NAFLD fibrosis score (random-effects HR 3.48, 95% CI 1.92-6.31). Sensitivity analyses and publication bias did not alter these findings.

CONCLUSIONS

Lean NAFLD is significantly associated with at least twofold increased risk of incident diabetes in non-overweight subjects. This risk parallels the underlying severity of NAFLD. The presence of NAFLD in non-overweight individuals had a more significant impact on the development of diabetes than being overweight itself.

Association of metabolic syndrome with depression in US adults: A nationwide cross-sectional study using propensity score-based analysis

Background

The association of metabolic syndrome (MetS) with depression has been previously reported; however, the results are ambiguous due to imbalanced confounding factors. Propensity score-based analysis is of great significance to minimize the impact of confounders in observational studies. Thus, the current study aimed to clarify the influence of MetS on depression incidence in the U.S. adult population by using propensity score (PS)-based analysis.

Methods

Data from 11,956 adults aged 20-85 years from the National Health and Nutrition Examination Survey (NHANES) database between 2005 and 2018 were utilized. Using 1:1 PS matching (PSM), the present cross-sectional study included 4,194 participants with and without MetS. A multivariate logistic regression model and three PS-based methods were applied to assess the actual association between MetS and depression incidence. Stratified analyses and interactions were performed based on age, sex, race, and components of MetS.

Results

After PSM, the risk of developing depression in patients with MetS increased by 40% in the PS-adjusted model (OR = 1.40, 95% confidence interval [CI]: 1.202-1.619, P < 0.001), and we could still observe a positive association in the fully adjusted model (OR = 1.37, 95% CI: 1.172-1.596, P < 0.001). Regarding the count of MetS components, having four and five conditions significantly elevated the risk of depression both in the PS-adjusted model (OR = 1.78, 95% CI: 1.341-2.016, P < 0.001 vs. OR = 2.11, 95% CI: 1.626-2.699, P < 0.001) and in the fully adjusted model (OR = 1.56, 95 CI%: 1.264-1.933, P < 0.001 vs. OR = 1.90, 95% CI: 1.458-2.486, P < 0.001). In addition, an elevation in MetS component count was associated with a significant linear elevation in the mean score of PHQ-9 (F =2.8356, P < 0.001). In the sensitivity analysis, similar conclusions were reached for both the original and weighted cohorts. Further interaction analysis revealed a clear gender-based difference in the association between MetS and depression incidence.

Conclusion

MetS exhibited the greatest influence on depression incidence in US adults, supporting the necessity of early detection and treatment of depressive symptoms in patients with MetS (or its components), particularly in female cases.

Association Between Hypertension and New-Onset Non-Alcoholic Fatty Liver Disease in Chinese Non-Obese People: A Longitudinal Cohort Study

BACKGROUND

Quantification of the relationship between hypertension and non-alcoholic fatty liver disease (NAFLD) risk is limited and controversial. This study aimed to investigate the relationship between hypertension and NAFLD in non-obese Chinese and to use different methods to demonstrate that hypertension is an independent risk factor for NAFLD.

METHODS

On 16,153 nonobese individuals, a retrospective cohort study was conducted in China to examine the impact of hypertension on incident NAFLD. We compared five methods: multivariable Cox proportional-hazards regression, propensity score-matched (PSM) analysis, propensity score adjustment method (considering the propensity score as a covariate in a multivariable Cox proportional-hazard regression), and two propensity score-based weighted methods-The first one estimated the hypertension effect in the overall study population-inverse probability of treatment weights (IPTW), the other in the hypertensive population-standardized mortality ratio (SMR) weights. We also used a genetic matching (GenMatch) algorithm to match the participants for sensitive analysis.

RESULTS

Between 2010 and 2014, 16,153 participants met our inclusion criteria, including 2427 (15.03%) with hypertension. A total of 2321 (14.37%) participants developed NAFLD during the median follow-up of 2.98 years. The crude hazard ratio (HR) between hypertension and incident NAFLD was 2.05 (95% confidence interval (CI): 1.87, 2.25). The adjusted HR depended on the different methods, ranging from 1.09 (95% CI: 0.77, 1.23) for the PSM method to 2.24 (95% CI: 2.05, 2.44) for the SMR weighted analysis. Hypertensive participants with high propensity scores had a higher risk of developing NAFLD in the future. Excluding participants with propensity scores <8% yielded comparable hazard ratios with a narrower range, from 1.04 to 1.80. After adjusting for the confounding variables, the relationship also existed in the GenMatch cohort as a sensitivity analysis (HR=1.06, 95% CI 1.01-1.13).

CONCLUSION

Hypertension is a significant cause of NAFLD in Chinese adults in non-obese Chinese adults, with the hazard ratio ranging from 1.09 to 2.24.

Association between serum uric acid-to-creatinine ratio and non-alcoholic fatty liver disease: a cross-sectional study in Chinese non-obese people with a normal range of low-density lipoprotein cholesterol

Objective

Evidence regarding the relationship between serum uric acid-to-creatinine (SUA/Scr) ratio and non-alcoholic fatty liver disease (NAFLD) in Chinese non-obese people is still limited. Therefore, the present study was undertaken to analyze the association between the SUA/Scr ratio and NAFLD.

Methods

This study was a cross-sectional study that non-selectively and consecutively collected 182,320 non-obese individuals with a normal range of low-density lipoprotein cholesterol in a Chinese hospital from January 2010 to December 2014. A binary logistic regression model was used to evaluate the independent association between the SUA/Scr ratio and NAFLD. A generalized additive model (GAM) and smooth curve fitting (penalized spline method) was conducted to explore the exact shape of the curve between them. A series of sensitivity analyses were used to ensure the robustness of the results. Moreover, subgroup analyses were conducted. In addition, the diagnostic value of the SUA/Scr ratio for NAFLD was evaluated based on the area under the receiver-operating characteristic curve (AUROC). It was stated that the data had been uploaded to the DATADRYAD website.

Results

The average participants' age was 40.96 ± 14.05 years old, and 90,305 (49.5%) were male. The prevalence of NAFLD was 13.7%, and the mean SUA/Scr was 3.62 ± 0.92. After adjusting covariates, the results showed that SUA/Scr ratio was positively associated with NAFLD (OR = 1.424, 95%CI: 1.396, 1.454). There was also a non-linear relationship between SUA/Scr ratio and NAFLD in participants with normal kidney function, and the inflection point of the SUA/Scr ratio was 4.425. The effect sizes (OR) on the left and right sides of the inflection point were 1.551 (1.504, 1.599) and 1.234 (1.179, 1.291), respectively. And the sensitive analysis demonstrated the robustness of the results. Subgroup analysis showed a stronger association between SUA/Scr ratio and NAFLD in females and the population with age < 50 years, FPG ≤ 6.1 mmol/L, BMI < 24 kg/m², and HDL-c ≥ 1 mmol/L. In contrast, the weaker association was probed in males and the population with age ≥ 50 years, BMI ≥ 24 kg/m², FPG > 6.1 mmol/L, and HDL-c < 1 mmol/L. The SUA/Scr ratio had an AUC of 0.6624 (95% CI 0.6589, 0.6660) for diagnosing NAFLD. Based on the best cut-off value of 3.776, the negative predictive value of the SUA/Scr ratio for identifying NAFLD was 91.0%.

Conclusion

This study demonstrates an independent positive association between SUA/Scr ratio and NAFLD in Chinese non-obese people with a normal range of low-density lipoprotein cholesterol. There is also a non-linear relationship between the SUA/Scr ratio and NAFLD in participants with normal kidney function, and the SUA/Scr ratio is strongly related to NAFLD when SUA/Scr ratio is less than 4.425. The SUA/Scr ratio has a certain reference value for determining NAFLD. When the SUA/Scr ratio is lower than 3.776, identifying NAFLD patients with low risk is a great reference.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-022-02500-w.

Elevated gamma-glutamyl transferase to high-density lipoprotein cholesterol ratio has a non-linear association with incident diabetes mellitus: A second analysis of a cohort study

OBJECTIVE

Evidence regarding the association between the GGT/HDL-c ratio and incident diabetes is still limited. On that account, our research aims to survey the link of the GGT/HDL-c ratio with the risk of diabetes.

METHODS

In this retrospective cohort study, data of 15,171 participants who participated in the medical examination program were collected in Murakami Memorial Hospital in Japan from 2004 to 2015. The independent and dependent variables were the baseline GGT/HDL-c ratio and diabetes during the follow-up, respectively. The Cox proportional-hazards regression model was used to explore the association between the GGT/HDL-c ratio and diabetes risk. A Cox proportional hazards regression with the cubic spline smoothing was used to recognize non-linear relationships between the GGT/HDL-c ratio and incident diabetes.

RESULTS

After adjusting covariates, the results showed that the GGT/HDL-c ratio was positively associated with incident diabetes (HR = 1.013, 95% CI: 1.002, 1.024). There was also a non-linear relationship between the GGT/HDL-c ratio and the risk of diabetes, and the inflection point of the GGT/HDL-c ratio was 6.477. The HR on the left and right sides of the inflection point was 2.568 (1.157, 5.699) and 1.012 (1.001, 1.023), respectively. The sensitivity analysis demonstrated the robustness of the results. Besides, the performance of the FPG + GGT/HDL-c ratio was better than FPG + GGT, FPG + HDL-c, and FPG in predicting diabetes.

CONCLUSION

This study demonstrates a positive and non-linear relationship between the GGT/HDL-c ratio and incident diabetes in the Japanese population. The GGT/HDL-c ratio is strongly related to diabetes risk when it is <6.477.

Association between central obesity and incident diabetes mellitus among Japanese: a retrospective cohort study using propensity score matching

Previous evidence revealed that central obesity played a vital role in the development of diabetes mellitus (DM). However, because of imbalanced confounding variables, some studies have not wholly established the association between central obesity and diabetes. Propensity score matching (PSM) analysis can minimize the impact of potential confounding variables. Therefore, the aim of the present study was to explore the relationship between central obesity and diabetes in the Japanese population by using PSM analysis. This retrospective cohort study included 15,453 Japanese adults who were free of diabetes at baseline between 2004 and 2015, which provided all medical records for individuals participating in the physical exam. Central obesity at baseline was an independent variable, and incident diabetes during follow-up was an outcome variable. Using a 1:1 PSM analysis, the present retrospective cohort study included 1639 adults with and without central obesity. Additionally, we employed a doubly robust estimation method to identify the association between central obesity and diabetes. Subjects with central obesity were 92% more likely to develop DM (HR = 1.65, 95%CI 1.12, 2.41). After adjusting for covariates, subjects with central obesity had a 72% increased risk of developing DM compared with subjects with non-central obesity in the PSM cohort (HR = 1.72, 95% CI 1.16, 2.56). Central obesity individuals had a 91% higher risk of DM than non-central obesity individuals, after adjustment for propensity score (HR = 1.91, 95% CI 1.29, 2.81). In sensitivity analysis, the central obesity group had a 44% (HR = 1.44, 95% CI 1.09, 1.90) and 59% (HR = 1.59, 95% CI1.35, 1.88) higher risk of DM than the non-central obesity group in the original and weighted cohorts after adjusting for confounding variables, respectively. Central obesity was independently associated with an increased risk of developing diabetes. After adjustment for confounding covariates, central obesity participants had a 72% higher risk of development of diabetes than non-central obesity individuals in the PSM cohort.

Chronic hypoxia prolongs postoperative mechanical ventilation and reduces the left atrial pressure threshold in children with tetralogy of Fallot

BACKGROUND

Chronic hypoxia induces pulmonary microvascular endothelial dysfunction. The left atrial pressure (LAP) represents the hydrostatic pressure of pulmonary microcirculation. The conjunction of the LAP and any abnormal pulmonary microvascular endothelial barrier function will have an impact on pulmonary exudation, resulting in prolonged mechanical ventilation. This study aimed to investigate the tolerance threshold of the pulmonary microcirculation to LAP in children with tetralogy of Fallot (TOF) to avoid prolonged mechanical ventilation after surgery.

METHODS

This retrospective study included 297 Chinese patients who underwent TOF correction at Fuwai Hospital. Patients were categorized according to their preoperative oxygen saturation (SpO₂) level. One-to-one propensity score matching (PSM) revealed a total of 126 participants in the SpO₂< 90% and SpO₂≥ 90% groups. Between-group comparisons were conducted to verify the correlation between hypoxia and prolonged mechanical ventilation. A subgroup analysis was performed to reveal the significant role of postoperative LAP stewardship on prolonged mechanical ventilation.

RESULTS

Failure to extubate within the first 48 h (23.81% vs. 9.52%, P = 0.031) and prolonged mechanical ventilation (26.98% vs. 11.11%, P = 0.023) were more commonly observed in children with preoperative SpO₂ < 90%. The incidence of prolonged mechanical ventilation consistently increased with LAP in both the SpO₂ < 90% and SpO₂ ≥ 90% groups, although LAP was still within the normal range (6-12 mmHg). Children in chronic hypoxic conditions tolerated lower LAP well. The tolerance threshold for postoperative LAP in children diagnosed with TOF under chronic hypoxic conditions was identified as 7 mmHg.

CONCLUSIONS

Children in a chronic hypoxic state may suffer from a high incidence of prolonged mechanical ventilation after surgical correction of TOF and may not tolerate higher postoperative LAP. To improve pulmonary prognosis, it is better to control and maintain the postoperative LAP at a lower state (≤7 mmHg) in children with chronic hypoxia.

Nonlinear relationship between aspartate aminotransferase to alanine aminotransferase ratio and the risk of prediabetes: A retrospective study based on chinese adults

OBJECTIVE

Recent evidence has revealed that the aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT ratio) may be closely associated with metabolic syndrome and insulin resistance. However, it is unclear whether the AST/ALT ratio correlates with prediabetes risk. The aim of our study was to examine the association between AST/ALT ratios and the risk of prediabetes among a large cohort of Chinese subjects.

METHODS

This retrospective cohort study recruited 75204 Chinese adults with normoglycemia at baseline who underwent physical examinations at the Rich Healthcare Group from 2010 to 2016. The AST/ALT ratio at baseline was the target independent variable, and the risk of developing prediabetes during follow-up was the dependent variable. Cox proportional-hazards regression was used to evaluate the independent association between the AST/ALT ratio and prediabetes. This study identified nonlinear relationships by applying a generalized additive model (GAM) and smooth curve fitting. In order to assess the robustness of this study, we performed a series of sensitivity analyses. Moreover, we performed a subgroup analysis to evaluate the consistency of the association in different subgroups. Data from this study have been updated on the DATADRYAD website.

RESULTS

The AST/ALT ratio was negatively and independently related to the prediabetes risk among Chinese adults (HR: 0.76, 95% CI: 0.75-0.84, P&lt;0.0001) after adjusting demographic and biochemical covariates. Furthermore, a nonlinear relationship between the AST/ALT ratio and the risk of developing prediabetes was found at an inflection point of 1.50 for the AST/ALT ratio. When the AST/ALT ratio was to the left of the inflection point (AST/ALT ratio ≤ 1.50), the AST/ALT ratio was negatively related to the prediabetes risk (HR:0.70, 95%CI: 0.65-0.76, P&lt;0.0001). In contrast, the relationship tended to be saturated when the AST/ALT ratio was more than 1.50 (HR: 1.01, 95%CI: 0.89-1.15, P=0.8976). Our findings remained robust across a range of sensitivity analyses. Subgroup analysis revealed that other variables did not alter the relationship between the AST/ALT ratio and prediabetes risk.

CONCLUSION

This study revealed that AST/ALT ratio was negatively and independently associated with prediabetes risk among Chinese participants. The relationship between the AST/ALT ratio and prediabetes risk was nonlinear, and AST/ALT ratio ≤ 1.50 was strongly inversely correlated with prediabetes risk.

Triglyceride: A mediator of the association between waist-to-height ratio and non-alcoholic fatty liver disease: A second analysis of a population-based study

OBJECTIVE

Increasing evidence suggests that an increased waist-to-height ratio (WHtR) may increase the risk of non-alcoholic fatty liver disease (NAFLD). Whether this association is due to WHtR itself or mediated by WHtR-associated increases in triglyceride (TG) is uncertain. On that account, our research aims to disentangle these relationships.

METHODS

In this cross-sectional study, 14251 participants who participated in the medical examination program were consecutively and non-selectively collected in Murakami Memorial Hospital in Japan from 2004 to 2015. The independent and dependent variables were WHtR and NAFLD, respectively. Triglyceride was the mediating factor. The correlation between WHtR, TG, and NAFLD risk factors was examined using spearman correlation analysis. The association between WHtR or TG and NAFLD was examined using multiple logistic regression. In order to determine whether TG mediated the association between WHtR and NAFLD, a mediation analysis was performed.

RESULTS

The mean age of the included individuals was 43.53 ± 8.89 years old, and 7411 (52.00%) were male. The mean WHtR and TG were 0.46 ± 0.05, 0.89 ± 0.63, respectively. The prevalence rate of NAFLD was 2507 (17.59%). Individuals with NAFLD had significantly higher levels of WHtR and TG than those without NAFLD (P&lt;0.05). After adjusting covariates, the multivariate linear regression analysis showed that WHtR was positively associated with TG. That was, for every 0.1 increase in WHtR, TG increased by 0.226mmol/L (β=0.226, 95%CI: 0.206, 0.247). Multiple logistic regression analysis indicated that WHtR (OR=8.743, 95%CI: 7.528, 10.153) and TG (OR=1.897, 95%CI: 1.732, 2.078) were positively associated with NAFLD. The mediation analysis showed that WHtR had a direct, significant effect on NAFLD (β=0.139, 95%CI: 0.126, 0.148), and TG partially mediated the indirect effect of WHtR on NAFLD (β=0.016, 95% CI: 0.013-0.019). TG contributed to 10.41% of WHtR-related NAFLD development.

CONCLUSION

Findings suggest a mediation link between WHtR and TG and the risk of NAFLD. The significance of TG as a mediator deserves recognition and consideration.

Association Between Aspartate Aminotransferase to Alanine Aminotransferase Ratio and Incidence of Type 2 Diabetes Mellitus in the Japanese Population: A Secondary Analysis of a Retrospective Cohort Study

BACKGROUND

The study on the association between aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio and the risk of type 2 diabetes mellitus (T2DM) was limited. Therefore, we conducted a secondary analysis based on online data to explore whether there was an association between the AST/ALT ratio and incident T2DM among a large number of Japanese people.

METHODS

The study was a retrospective cohort study. We downloaded the NAGALA (NAfld in Gifu area) data from DATADRYAD website between 2004 and 2015. This present study included 15,291 participants. Cox proportional-hazards regression, generalized additive models and subgroup analyses were used to find out the association between the AST/ALT ratio and T2DM events.

RESULTS

The negative relationship was shown between AST/ALT ratio and incident T2DM (HR = 0.617, 95% CI: 0.405-0.938) in our study. A non-linear relationship and saturation effect were found between them, and the inflection point was 0.882. It indicated that the AST/ALT ratio was negatively correlated with incident T2DM when the AST/ALT ratio was less than the inflection point (HR = 0.287, 95% CI: 0.126-0.655, p = 0.0030). We found that exercise modified their relationship (P for interaction = 0.0024), and people who did not exercise associated strongly (HR = 0.464 95% CI: 0.290-0.741).

CONCLUSION

AST/ALT ratio was negatively associated with T2DM risk, and their relationship was non-linear and had a saturation effect. When the AST/ALT ratio was less than 0.882, they showed a significant negative correlation.