title: Independent Association Between Improvement of Nonalcoholic Fatty Liver Disease and Reduced Incidence of Type 2 Diabetes.
abstract: OBJECTIVE
  Only a few studies have evaluated the long-term effects of nonalcoholic fatty liver disease (NAFLD) on type 2 diabetes mellitus (T2DM), and none have examined whether NAFLD improvement reduces T2DM incidence. We investigated the association between NAFLD improvement and T2DM incidence.
  
  
  METHODS
  Between 2000 and 2012, 4,604 participants who underwent a health check twice with >10 years between were enrolled. Exclusion criteria were positive hepatitis B surface antigen, positive hepatitis C antibody, ethanol intake >20 g/day, and diabetes. The 3,074 eligible participants were divided into an NAFLD group (n = 728) and a non-NAFLD group (n = 2,346) according to ultrasonography-detected fatty liver. The NAFLD group was categorized into an improved group (n = 110) and a sustained NAFLD group (n = 618) based on fatty liver disappearance at the second visit. Incident T2DM odds ratios (ORs) were estimated by logistic regression models adjusted for age, sex, BMI, impaired fasting glucose, family history of diabetes, dyslipidemia, hypertension, and physical exercise.
  
  
  RESULTS
  T2DM occurred in 117 participants (16.1%) in the NAFLD group and 72 (3.1%) in the non-NAFLD group. NAFLD at baseline was associated with T2DM incidence (multivariate OR 2.37 [95% CI 1.60-3.52]). T2DM occurred in 7 participants (6.4%) in the improved group and in 110 (17.8%) in the sustained NAFLD group. NAFLD improvement was associated with reduced T2DM incidence (multivariate OR 0.27 [95% CI 0.12-0.61]).
  
  
  CONCLUSIONS
  NAFLD improvement is associated with T2DM incidence reduction.
authors.affiliation: Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan yamazaki-myz@umin.ac.jp.
authors.forename: Hajime
authors.identifier: http://orcid.org/0000-0002-9034-4370
authors.initials: H
authors.lastname: Yamazaki
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Tsuboya
authors.affiliation: Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Tsuji
authors.affiliation: Department of Health Checkup and Promotion, Keijinkai Maruyama Clinic, Sapporo, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Dohke
authors.affiliation: Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Maguchi
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology* / Q000517:prevention & control*; D016017:Odds Ratio; D011236:Prediabetic State / Q000453:epidemiology; D012307:Risk Factors