title: Influence of non-alcoholic fatty liver disease on the development of diabetes mellitus.
abstract: OBJECTIVE
  Non-alcoholic fatty liver disease (NAFLD) is linked to metabolic syndrome, and is known to be associated with impaired fasting glycemia and diabetes mellitus. This prospective community-based study was conducted to determine the association between NAFLD and incidence of diabetes mellitus in an urban adult population in Sri Lanka.
  
  
  METHODS
  Participants of the Ragama Health Study cohort were assessed for NAFLD using established ultrasound criteria in 2007. Those who were free of diabetes at baseline were followed up for 3 years. Incidence rates of diabetes mellitus were compared between subjects with and without NAFLD at baseline.
  
  
  RESULTS
  Out of 2984 subjects, 926 had NAFLD and 676 had diabetes in 2007. Of the 2276 subjects who were free of diabetes in 2007, 1914 were re-assessed in 2010. After 3 years, 104 out of 528 subjects with NAFLD and 138 out of 1314 subjects without NAFLD had developed diabetes mellitus de novo. Incidence rates of diabetes were respectively 64.2 and 34 per 1000 person-years of follow up for those with and without NAFLD. NAFLD was an independent predictor of developing diabetes mellitus. Other independent predictors were impaired fasting glycemia and dyslipidemia.
  
  
  CONCLUSIONS
  Subjects with ultrasonically diagnosed NAFLD have an increased risk of developing diabetes mellitus. Intervention for NAFLD through lifestyle modification may prevent progression of the current diabetes epidemic.
authors.affiliation: Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. akasturiratne@yahoo.com
authors.forename: Anuradhani
authors.initials: A
authors.lastname: Kasturiratne
authors.forename: Sanjaya
authors.initials: S
authors.lastname: Weerasinghe
authors.forename: Anuradha S
authors.initials: AS
authors.lastname: Dassanayake
authors.forename: Shaman
authors.initials: S
authors.lastname: Rajindrajith
authors.forename: Arjuna P
authors.initials: AP
authors.lastname: de Silva
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kato
authors.forename: A Rajitha
authors.initials: AR
authors.lastname: Wickremasinghe
authors.forename: H Janaka
authors.initials: HJ
authors.lastname: de Silva
mesh_terms: D000328:Adult; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000209:etiology; D050171:Dyslipidemias / Q000453:epidemiology; D005234:Fatty Liver / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013188:Sri Lanka / Q000453:epidemiology; D014463:Ultrasonography; D014505:Urban Population