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Nonalcoholic fatty liver disease is associated with coronary artery calcium score in diabetes patients with higher HbA1c.

Kwak MS, Yim JY, Kim D, Park MJ, Lim SH, Yang JI, Chung GE, Kim YS, Yang SY, Kim MN, Lee CH, Yoon JH, Lee HS - Diabetol Metab Syndr (2015)

Bottom Line: Diabetes was defined as cases with fasting serum glucose ≥ 126 mg/dl, glycated hemoglobin (HbA1c) ≥ 6.5%, or those taking anti-diabetic medications.Multivariate linear regression analyses were performed with use of the interaction term of NAFLD × glycemic level and other confounders of CACS such as age, sex, hypertension, body mass index, waist circumference, HDL cholesterol and triglyceride.NAFLD was independently associated with CACS only in diabetes patients with higher HbA1c, after adjustment for confounders.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, 39FL., Gangnam Finance Center 737, Yeoksam-Dong, Seoul, 135-984 Gangnam-Gu Korea.

ABSTRACT

Background: In patients with diabetes, studies investigating the association between nonalcoholic fatty liver disease (NAFLD) and coronary artery calcium score (CACS) have shown conflicting results. The aim of this study was to evaluate the association between NAFLD and CACS in diabetic patients.

Methods: This is the cohort study performed in Seoul National University Hospital Gangnam Healthcare Center. NAFLD was defined as cases with the typical ultrasonographic findings without excessive alcohol consumption, medications causing hepatic steatosis or other chronic liver diseases. CACS was evaluated using the Agatston method. Diabetes was defined as cases with fasting serum glucose ≥ 126 mg/dl, glycated hemoglobin (HbA1c) ≥ 6.5%, or those taking anti-diabetic medications. Multivariate linear regression analyses were performed with use of the interaction term of NAFLD × glycemic level and other confounders of CACS such as age, sex, hypertension, body mass index, waist circumference, HDL cholesterol and triglyceride.

Results: A total of 213 participants with diabetes were included in the study. As 77 subjects (36.2%) had CACS 0, causing left sided skewness, CACS was analyzed after log transformation to Ln (CACS + 1). A statistically significant interaction was observed between NAFLD and HbA1c ≥ 7% (P for interaction = 0.014). While NAFLD was not associated with CACS in the group with HbA1c < 7% (P = 0.229), it was significantly associated in the group with HbA1c ≥ 7% (P = 0.010) after adjusting for covariates in multivariate analyses.

Conclusions: This study demonstrated an effect modification of glycemic level on the association between NAFLD and CACS. NAFLD was independently associated with CACS only in diabetes patients with higher HbA1c, after adjustment for confounders.

No MeSH data available.


Related in: MedlinePlus

Flowchart showing details of inclusion and exclusion of the subjects.
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Fig1: Flowchart showing details of inclusion and exclusion of the subjects.

Mentions: Patients who visited the Seoul National University Hospital Gangnam Healthcare Center for health screening between July 2011 to July 2012 and performed coronary calcium-scoring computed tomography, hepatic ultrasonography, and baseline laboratory exams were initially included in the study. Subjects with other potential causes of chronic liver disease were excluded as follows: subjects with excessive alcohol consumption (>30 g/day for men and > 20 g/day for women), with hepatitis B virus (determined by the presence of the hepatitis B surface antigen), with the hepatitis C virus (determined by the presence of the hepatitis C antibody), or with some other history of hepatitis, as identified using a detailed medical history and a questionnaire (primary biliary cirrhosis, Wilson’s disease, hemochromatosis, and autoimmune hepatitis). Subjects taking medications that can account for steatosis (e.g. tamoxifen, amiodarone, methotrexate) during the previous year were also excluded. Among them, we selected the patients who were diagnosed with diabetes. The presence of diabetes was defined as having either a fasting serum glucose level equal to or greater than 126 mg/dL, glycated hemoglobin (HbA1c) ≥ 6.5% or consuming medication for diabetes. Participants who had a history of heart attack, coronary artery disease including acute myocardial infarction, angina, or congestive heart failure were also excluded. Figure 1 shows flowchart of the inclusion and exclusion of the patients.Figure 1


Nonalcoholic fatty liver disease is associated with coronary artery calcium score in diabetes patients with higher HbA1c.

Kwak MS, Yim JY, Kim D, Park MJ, Lim SH, Yang JI, Chung GE, Kim YS, Yang SY, Kim MN, Lee CH, Yoon JH, Lee HS - Diabetol Metab Syndr (2015)

Flowchart showing details of inclusion and exclusion of the subjects.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4384364&req=5

Fig1: Flowchart showing details of inclusion and exclusion of the subjects.
Mentions: Patients who visited the Seoul National University Hospital Gangnam Healthcare Center for health screening between July 2011 to July 2012 and performed coronary calcium-scoring computed tomography, hepatic ultrasonography, and baseline laboratory exams were initially included in the study. Subjects with other potential causes of chronic liver disease were excluded as follows: subjects with excessive alcohol consumption (>30 g/day for men and > 20 g/day for women), with hepatitis B virus (determined by the presence of the hepatitis B surface antigen), with the hepatitis C virus (determined by the presence of the hepatitis C antibody), or with some other history of hepatitis, as identified using a detailed medical history and a questionnaire (primary biliary cirrhosis, Wilson’s disease, hemochromatosis, and autoimmune hepatitis). Subjects taking medications that can account for steatosis (e.g. tamoxifen, amiodarone, methotrexate) during the previous year were also excluded. Among them, we selected the patients who were diagnosed with diabetes. The presence of diabetes was defined as having either a fasting serum glucose level equal to or greater than 126 mg/dL, glycated hemoglobin (HbA1c) ≥ 6.5% or consuming medication for diabetes. Participants who had a history of heart attack, coronary artery disease including acute myocardial infarction, angina, or congestive heart failure were also excluded. Figure 1 shows flowchart of the inclusion and exclusion of the patients.Figure 1

Bottom Line: Diabetes was defined as cases with fasting serum glucose ≥ 126 mg/dl, glycated hemoglobin (HbA1c) ≥ 6.5%, or those taking anti-diabetic medications.Multivariate linear regression analyses were performed with use of the interaction term of NAFLD × glycemic level and other confounders of CACS such as age, sex, hypertension, body mass index, waist circumference, HDL cholesterol and triglyceride.NAFLD was independently associated with CACS only in diabetes patients with higher HbA1c, after adjustment for confounders.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, 39FL., Gangnam Finance Center 737, Yeoksam-Dong, Seoul, 135-984 Gangnam-Gu Korea.

ABSTRACT

Background: In patients with diabetes, studies investigating the association between nonalcoholic fatty liver disease (NAFLD) and coronary artery calcium score (CACS) have shown conflicting results. The aim of this study was to evaluate the association between NAFLD and CACS in diabetic patients.

Methods: This is the cohort study performed in Seoul National University Hospital Gangnam Healthcare Center. NAFLD was defined as cases with the typical ultrasonographic findings without excessive alcohol consumption, medications causing hepatic steatosis or other chronic liver diseases. CACS was evaluated using the Agatston method. Diabetes was defined as cases with fasting serum glucose ≥ 126 mg/dl, glycated hemoglobin (HbA1c) ≥ 6.5%, or those taking anti-diabetic medications. Multivariate linear regression analyses were performed with use of the interaction term of NAFLD × glycemic level and other confounders of CACS such as age, sex, hypertension, body mass index, waist circumference, HDL cholesterol and triglyceride.

Results: A total of 213 participants with diabetes were included in the study. As 77 subjects (36.2%) had CACS 0, causing left sided skewness, CACS was analyzed after log transformation to Ln (CACS + 1). A statistically significant interaction was observed between NAFLD and HbA1c ≥ 7% (P for interaction = 0.014). While NAFLD was not associated with CACS in the group with HbA1c < 7% (P = 0.229), it was significantly associated in the group with HbA1c ≥ 7% (P = 0.010) after adjusting for covariates in multivariate analyses.

Conclusions: This study demonstrated an effect modification of glycemic level on the association between NAFLD and CACS. NAFLD was independently associated with CACS only in diabetes patients with higher HbA1c, after adjustment for confounders.

No MeSH data available.


Related in: MedlinePlus