Association between the Fatty Liver Index and Risk of Type 2 Diabetes in the EPIC-Potsdam Study

PLoS One. 2015 Apr 22;10(4):e0124749. doi: 10.1371/journal.pone.0124749. eCollection 2015.

Abstract

The fatty liver index (FLI) predicts fatty liver by using BMI, waist circumference, γ-glutamyltransferase and triglycerides. We investigated the association between the FLI and the risk of type 2 diabetes and evaluated to what extent single FLI components contribute to the diabetes risk. We analysed a case-cohort study (random sub-cohort: 1922; incident cases: 563) nested within the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study. The proportion of exposure effect (PEE) explained by single FLI components was evaluated and effect decomposition using inverse probability weighting (IPW) was applied. Women and men with a FLI ≥ 60 compared to those with a FLI < 30 had a multivariable-adjusted Hazard Ratio (HR) of 17.6; 95% confidence interval (CI) 11.1-28.0 and HR: 10.9; 95% CI 6.22-19.2, respectively. Adjustment for BMI or waist circumference attenuated this association in men [PEE BMI (95% CI) = 53.8% (43.9%-65.8%); PEE waist (95% CI) = 54.8% (44.2%-68.8%)]. In women, adjustment for waist circumference attenuated the association to a lesser degree than in men [PEE waist (95% CI) = 31.1%; (21.9%-43.1%)] while BMI had no appreciable effect [PEE BMI (95% CI) = 11.0% (2.68%-21.0%)]. γ-glutamyltransferase and triglycerides showed only a small attenuation in women [PEE GGT(95% CI) = 3.11% (-0.72%-4.48%); PEE TG (95% CI) = 6.36% (3.81%-9.92%)] and in men [PEE GGT = 0%; PEE TG (95% CI) = 6.23% (2.03%-11.8%)]. In women, the total effect was decomposed into a direct effect and 4 indirect effects (HR BMI = 1.10; HR waist = 1.28; HR GGT = 0.97 and HR TG = 1.03). In men, the 4 indirect effects were HR BMI = 1.25; HR waist = 1.29; HR GGT = 0.97 and HR TG = 0.99. These data suggest that the FLI, as a proxy for fatty liver, is associated with risk of type 2 diabetes. This association is only partly explained by standard estimates of overall and abdominal body fatness, particularly among women.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Confidence Intervals
  • Diabetes Mellitus, Type 2 / etiology*
  • Fatty Liver / complications*
  • Female
  • Germany
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors

Grants and funding

The recruitment phase of the EPIC-Potsdam Study was supported by the Federal Ministry of Science, Germany (grant 01 EA 9401) and the European Union (grant SOC 95201408 05 F02). The follow-up of the EPIC-Potsdam Study is supported by the German Cancer Aid (grant 70-2488-Ha I) and the European Community (grant SOC 98200769 05 F02). This study was supported in part by a grant from the German Federal Ministry of Education and Research (BMBF) to the German Center for Diabetes Research (DZD). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.