HbA1c of 5.8% or higher as the most useful indicator for recommendation of ultrasonography to detect nonalcoholic fatty liver disease

Miwa Tatsuta; Masafumi Ono; Shungo Kimura; Kaori Zuigyo; Yudai Sato; Akemi Tomida; Mitsuyoshi Kobayashi; Ritsuko Yoshikawa; Satoshi Murao; Joji Tani; Asahiro Morishita; Hideki Kobara; Takashi Himoto; Tsuyoshi Maeta; Yoshihiro Mori; Fumikazu Kohi; Tsutomu Masaki

doi:10.1002/jgh3.13019

HbA1c of 5.8% or higher as the most useful indicator for recommendation of ultrasonography to detect nonalcoholic fatty liver disease

JGH Open. 2023 Dec 11;7(12):990-997. doi: 10.1002/jgh3.13019. eCollection 2023 Dec.

Authors

Miwa Tatsuta^{1

2}, Masafumi Ono³, Shungo Kimura², Kaori Zuigyo¹, Yudai Sato¹, Akemi Tomida¹, Mitsuyoshi Kobayashi², Ritsuko Yoshikawa⁴, Satoshi Murao⁴, Joji Tani², Asahiro Morishita², Hideki Kobara², Takashi Himoto⁵, Tsuyoshi Maeta⁶, Yoshihiro Mori⁶, Fumikazu Kohi⁶, Tsutomu Masaki²

Affiliations

¹ Department of Gastroenterology KKR Takamatsu Hospital Kagawa Japan.
² Department of Gastroenterology and Neurology Faculty of Medicine, Kagawa University Kagawa Japan.
³ Division of Innovative Medicine for Hepatobiliary & Pancreatology Faculty of Medicine, Kagawa University Kagawa Japan.
⁴ Department of Endocrinology KKR Takamatsu Hospital Kagawa Japan.
⁵ Department of Medical Technology Kagawa Prefectural University of Health Sciences Kagawa Japan.
⁶ Department of Internal Medicine KKR Takamatsu Hospital Kagawa Japan.

Abstract

Background and aim: Nonalcoholic fatty liver disease (NAFLD) is closely associated with metabolic syndrome. This study was performed to examine the association between NAFLD and each factor of metabolic syndrome and to identify the factors that are most strongly associated with NAFLD in participants undergoing health checkups.

Methods: We studied 6538 participants who underwent a health checkup from 2017 to 2018 in our institution. Participants with alcohol intake exceeding 20 g/day or with other chronic liver diseases were excluded. Fatty liver was detected by ultrasonography.

Results: In total, 4310 participants were enrolled, and 28.4% had fatty liver (NAFLD). The prevalence of NAFLD was highest in the diabetes mellitus (DM)-only group than in the dyslipidemia-only or hypertension-only group. The DM-only group was the only group whose prevalence of NAFLD was >50% in the overall study and in males. The prevalence of NAFLD was higher in males than in females in the DM-only, hypertension-only, and dyslipidemia-only groups. The prevalence of NAFLD was >70% in the dyslipidemia and DM combined group. Multivariate analysis showed that gender and HbA1c were the independent factors most strongly associated with NAFLD. The cutoff value for HbA1c by receiver operating characteristic curve analysis was 5.8% (sensitivity, 57.9%; specificity, 72.6%; area under the curve, 0.70).

Conclusion: NAFLD was most strongly associated with DM, among the various components of metabolic syndrome. We strongly recommend abdominal ultrasonography to detect NAFLD in patients with an HbA1c of ≥5.8% in general practice and during health checkups.

Keywords: HbA1c; diabetes mellitus; nonalcoholic fatty liver disease; ultrasonography.