title: Assessment of the fatty liver index as an indicator of hepatic steatosis for predicting incident diabetes independently of insulin resistance in a Korean population.
abstract: OBJECTIVE
  Fatty liver disease, especially non-alcoholic fatty liver disease, is considered to be the hepatic manifestation of the metabolic syndrome, both closely associated with insulin resistance. Furthermore, fatty liver disease assessed by ultrasonography is known to be a predictor of the development of Type 2 diabetes mellitus. However, it remains unclear whether fatty liver disease plays a role in the pathogenesis of Type 2 diabetes independently of insulin resistance. In this study, we investigated whether fatty liver disease assessed by the fatty liver index can predict the development of Type 2 diabetes independently of systemic insulin resistance.
  
  
  METHODS
  We examined the clinical and laboratory data of 7860 subjects without diabetes who underwent general routine health evaluations at the Asan Medical Center in 2007 and had returned for follow-up examinations in 2011. Fatty liver index was calculated using an equation that considers serum triglyceride levels, γ-glutamyltransferase, waist circumference and BMI.
  
  
  RESULTS
  During a 4-year period, 457 incident diabetes cases (5.8%) were identified. The odds ratios for the development of Type 2 diabetes were significantly higher in the group with a fatty liver index ≥ 60 (fatty liver index-positive) than in the group with a fatty liver index < 20 (fatty liver index-negative) after adjusting for various confounding variables including homeostasis model assessment of insulin resistance. Odds ratios were significant regardless of the insulin resistance status at baseline.
  
  
  CONCLUSIONS
  Our results suggest that fatty liver index as a simple surrogate indicator of hepatic steatosis is valuable in identifying subjects at high risk for Type 2 diabetes. In addition, fatty liver disease itself contributes to the development of Type 2 diabetes independently of systemic insulin resistance.
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: C H
authors.initials: CH
authors.lastname: Jung
authors.forename: W J
authors.initials: WJ
authors.lastname: Lee
authors.forename: J Y
authors.initials: JY
authors.lastname: Hwang
authors.forename: J H
authors.initials: JH
authors.lastname: Yu
authors.forename: M S
authors.initials: MS
authors.lastname: Shin
authors.forename: M J
authors.initials: MJ
authors.lastname: Lee
authors.forename: J E
authors.initials: JE
authors.lastname: Jang
authors.forename: J
authors.initials: J
authors.lastname: Leem
authors.forename: J-Y
authors.initials: JY
authors.lastname: Park
authors.forename: H-K
authors.initials: HK
authors.lastname: Kim
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005234:Fatty Liver / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014280:Triglycerides / Q000378:metabolism; D055105:Waist Circumference; D005723:gamma-Glutamyltransferase / Q000378:metabolism
chemical_list: D014280:Triglycerides; D005723:gamma-Glutamyltransferase