Diabetes Metab J.  2024 May;48(3):440-448. 10.4093/dmj.2023.0200.

Glycemic Control Is Associated with Histological Findings of Nonalcoholic Fatty Liver Disease

• Miyake T
• Furukawa S
• Matsuura B
• Yoshida O
• Miyazaki M
• Shiomi A
• Kanamoto A
• Nakaguchi H
• Nakamura Y
• Imai Y
• Koizumi M
• Watanabe T
• Yamamoto Y
• Koizumi Y
• Tokumoto Y
• Hirooka M
• Kumagi T
• Takesita E
• Ikeda Y
• Abe M
• Hiasa Y

• KMID: 2555775
• DOI: http://doi.org/10.4093/dmj.2023.0200

Abstract

Background
Poor lifestyle habits may worsen nonalcoholic fatty liver disease (NAFLD), with progression to nonalcoholic steatohepatitis (NASH) and cirrhosis. This study investigated the association between glycemic control status and hepatic histological findings to elucidate the effect of glycemic control on NAFLD.
Methods
This observational study included 331 patients diagnosed with NAFLD by liver biopsy. Effects of the glycemic control status on histological findings of NAFLD were evaluated by comparing the following four glycemic status groups defined by the glycosylated hemoglobin (HbA1c) level at the time of NAFLD diagnosis: ≤5.4%, 5.5%–6.4%, 6.5%–7.4%, and ≥7.5%.
Results
Compared with the lowest HbA1c group (≤5.4%), the higher HbA1c groups (5.5%–6.4%, 6.5%–7.4%, and ≥7.5%) were associated with advanced liver fibrosis and high NAFLD activity score (NAS). On multivariate analysis, an HbA1c level of 6.5%– 7.4% group was significantly associated with advanced fibrosis compared with the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index and uric acid, total cholesterol, and triglyceride levels, the higher HbA1c groups were significantly associated with advanced fibrosis compared with the lowest HbA1c group. On the other hand, compared with the lowest HbA1c group, the higher HbA1c groups were also associated with a high NAS in both multivariate analyses.
Conclusion
Glycemic control is associated with NAFLD exacerbation, with even a mild deterioration in glycemic control, especially a HbA1c level of 6.5%–7.4%, contributing to NAFLD progression.

Keyword

Glycated hemoglobin; Glycemic control; Non-alcoholic fatty liver disease

Figure

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  Fig. 1. Association between components of HbA1c. (A) Steatosis grade. (B) Lobular inflammation. (C) Ballooned hepatocytes. The chi-square test was used to analyze categorical variables, with significance set at a P<0.05.

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