title: Fatty liver score and 15-year incidence of type 2 diabetes.
abstract: OBJECTIVE
  Both non-alcoholic fatty liver (NAFL) and alcoholic fatty liver (AFL) are strongly associated with obesity, metabolic syndrome, and type 2 diabetes mellitus (T2DM). Recently, also the vitamin D level has been associated with these and may also be associated with fatty liver (FL). Liver function tests (LFTs) are insensitive markers of FL, but use of scores may help in identifying subjects with FL. We studied how LFTs and the FL score predict the development of T2DM in subjects with AFL versus NAFL and low versus high vitamin D levels.
  
  
  METHODS
  A cohort study based on 4,517 participants, aged 40-79, from the representative Mini-Finland Health Survey was carried out. During a follow-up of 15 years, 217 T2DM cases occurred. LFTs were determined from serum samples, and the FL score was formed using BMI, fasting glucose, HDL cholesterol, and GGT concentrations.
  
  
  RESULTS
  The risk of T2DM incidence in the highest versus lowest quartile was twofold for the LFTs and ninefold for the FL score. A total of 77 % (95 % confidence interval: 57-87 %) of the T2DM cases could have been prevented if all individuals' FL scores had been at the level of the first quartile. Heavy alcohol consumption and low serum vitamin D concentrations were associated with an increased risk of T2DM among individuals with high FL scores.
  
  
  CONCLUSIONS
  The FL score is a useful tool for diagnosing FL in epidemiological studies. A high FL score predicts increased risk of T2DM, especially when combined with heavy alcohol consumption or low vitamin D levels.
authors.affiliation: Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.|Department of Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Anna
authors.initials: A
authors.lastname: Kotronen
authors.affiliation: Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland. maarit.laaksonen@thl.fi.
authors.forename: Maarit A
authors.initials: MA
authors.lastname: Laaksonen
authors.affiliation: Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Heliövaara
authors.affiliation: Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Reunanen
authors.affiliation: Department of Public Health, University of Helsinki, Helsinki, Finland.|South Ostrobothnia Central Hospital, Seinäjoki, Finland.|Red RECAVA Grupo RD06/0014/0015, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Tuomilehto
authors.affiliation: Department of Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Hannele
authors.initials: H
authors.lastname: Yki-Järvinen
authors.affiliation: Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Peltonen
authors.affiliation: Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
authors.forename: Paul
authors.initials: P
authors.lastname: Knekt
keywords: Alcohol consumption; Attributable risk; Cohort studies; Fatty liver score; Liver fat; Liver function test; Type 2 diabetes; Vitamin D