Non-Alcoholic Fatty Liver Disease and the Risk of Diabetes Mellitus by Menopausal Status: A Nationwide Cohort Study
Background: Non-alcoholic fatty liver disease (NAFLD) is regarded as a risk factor for type 2 diabetes mellitus (DM). Menopausal status also influences T2DM risk, where estrogen is presumed to play a protective role by decreasing insulin resistance. As such, we investigated the association between N...
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| Format: | Article |
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MDPI AG
2022-03-01
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| Series: | Journal of Personalized Medicine |
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| Online Access: | https://www.mdpi.com/2075-4426/12/4/546 |
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| author | Jungeun Shin Soo Jung Choi Han Rim Lee Kyungdo Han Jiwon Chang Su-Min Jeong Yun-sun Choi Daeho Lee Dong Wook Shin |
| author_facet | Jungeun Shin Soo Jung Choi Han Rim Lee Kyungdo Han Jiwon Chang Su-Min Jeong Yun-sun Choi Daeho Lee Dong Wook Shin |
| author_sort | Jungeun Shin |
| collection | DOAJ |
| description | Background: Non-alcoholic fatty liver disease (NAFLD) is regarded as a risk factor for type 2 diabetes mellitus (DM). Menopausal status also influences T2DM risk, where estrogen is presumed to play a protective role by decreasing insulin resistance. As such, we investigated the association between NAFLD and DM risk according to menopausal status. Objectives: We sought to examine the association between NAFLD and DM incidence in pre- and post-menopausal women. Methods: A total of 842,772 pre-menopausal and 1,074,767 post-menopausal women who underwent health examinations between 2009 and 2014 were included from the Korean National Health Insurance Service database. Multivariate Cox proportional hazard analyses were performed to evaluate the association between the risk of DM according to menopausal status and NAFLD, defined by a fatty liver index >60. Results: During the mean follow-up period (7.8 years), DM was diagnosed in 33,461 (4.0%) of pre-menopausal women and 121,102 (9.4%) post-menopausal women. A stronger association between NAFLD and the risk of DM was found in pre-menopausal women (multivariable-adjusted hazard ratio [aHR], 3.60; 95% confidence interval [CI], 3.48–3.71) than in post-menopausal women (aHR, 2.24; 95% CI, 2.21–2.28) (<i>P</i>-interaction < 0.01). Subgroup analyses among women aged 45 to 55 years also showed a stronger association in pre-menopausal (aHR, 3.35; 95% CI, 3.21–3.49) than in post-menopausal women (aHR, 2.83; 95% CI, 2.68–2.98) (<i>P</i>-interaction < 0.01). Conclusions: The association between NAFLD and DM was stronger in pre-menopausal women than in post-menopausal women. This might be due to the protective effect of estrogen, which is possibly in higher production in the peripheral fat tissue of post-menopausal women with NAFLD. |
| first_indexed | 2024-03-09T10:33:27Z |
| format | Article |
| id | doaj.art-c4bf04f4e8344ba285bae3c0d28f995e |
| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-09T10:33:27Z |
| publishDate | 2022-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-c4bf04f4e8344ba285bae3c0d28f995e2023-12-01T21:08:42ZengMDPI AGJournal of Personalized Medicine2075-44262022-03-0112454610.3390/jpm12040546Non-Alcoholic Fatty Liver Disease and the Risk of Diabetes Mellitus by Menopausal Status: A Nationwide Cohort StudyJungeun Shin0Soo Jung Choi1Han Rim Lee2Kyungdo Han3Jiwon Chang4Su-Min Jeong5Yun-sun Choi6Daeho Lee7Dong Wook Shin8Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, KoreaDepartment of Family Medicine, Gachon University Gil Medical Center, Incheon 21565, KoreaDepartment of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, KoreaDepartment of Statistics and Actuarial Science, Soongsil University, Seoul 06978, KoreaTotal Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, KoreaDepartment of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, KoreaSamsung Medical Center, Department of Obstetrics and Gynecology, Sungkyunkwan University, Seoul 06351, KoreaDivision of Endocrinology, Department of Internal Medicine, Gil University Hospital, Incheon 21565, KoreaDepartment of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, KoreaBackground: Non-alcoholic fatty liver disease (NAFLD) is regarded as a risk factor for type 2 diabetes mellitus (DM). Menopausal status also influences T2DM risk, where estrogen is presumed to play a protective role by decreasing insulin resistance. As such, we investigated the association between NAFLD and DM risk according to menopausal status. Objectives: We sought to examine the association between NAFLD and DM incidence in pre- and post-menopausal women. Methods: A total of 842,772 pre-menopausal and 1,074,767 post-menopausal women who underwent health examinations between 2009 and 2014 were included from the Korean National Health Insurance Service database. Multivariate Cox proportional hazard analyses were performed to evaluate the association between the risk of DM according to menopausal status and NAFLD, defined by a fatty liver index >60. Results: During the mean follow-up period (7.8 years), DM was diagnosed in 33,461 (4.0%) of pre-menopausal women and 121,102 (9.4%) post-menopausal women. A stronger association between NAFLD and the risk of DM was found in pre-menopausal women (multivariable-adjusted hazard ratio [aHR], 3.60; 95% confidence interval [CI], 3.48–3.71) than in post-menopausal women (aHR, 2.24; 95% CI, 2.21–2.28) (<i>P</i>-interaction < 0.01). Subgroup analyses among women aged 45 to 55 years also showed a stronger association in pre-menopausal (aHR, 3.35; 95% CI, 3.21–3.49) than in post-menopausal women (aHR, 2.83; 95% CI, 2.68–2.98) (<i>P</i>-interaction < 0.01). Conclusions: The association between NAFLD and DM was stronger in pre-menopausal women than in post-menopausal women. This might be due to the protective effect of estrogen, which is possibly in higher production in the peripheral fat tissue of post-menopausal women with NAFLD.https://www.mdpi.com/2075-4426/12/4/546diabetes mellitusnonalcoholic fatty livermenopause |
| spellingShingle | Jungeun Shin Soo Jung Choi Han Rim Lee Kyungdo Han Jiwon Chang Su-Min Jeong Yun-sun Choi Daeho Lee Dong Wook Shin Non-Alcoholic Fatty Liver Disease and the Risk of Diabetes Mellitus by Menopausal Status: A Nationwide Cohort Study Journal of Personalized Medicine diabetes mellitus nonalcoholic fatty liver menopause |
| title | Non-Alcoholic Fatty Liver Disease and the Risk of Diabetes Mellitus by Menopausal Status: A Nationwide Cohort Study |
| title_full | Non-Alcoholic Fatty Liver Disease and the Risk of Diabetes Mellitus by Menopausal Status: A Nationwide Cohort Study |
| title_fullStr | Non-Alcoholic Fatty Liver Disease and the Risk of Diabetes Mellitus by Menopausal Status: A Nationwide Cohort Study |
| title_full_unstemmed | Non-Alcoholic Fatty Liver Disease and the Risk of Diabetes Mellitus by Menopausal Status: A Nationwide Cohort Study |
| title_short | Non-Alcoholic Fatty Liver Disease and the Risk of Diabetes Mellitus by Menopausal Status: A Nationwide Cohort Study |
| title_sort | non alcoholic fatty liver disease and the risk of diabetes mellitus by menopausal status a nationwide cohort study |
| topic | diabetes mellitus nonalcoholic fatty liver menopause |
| url | https://www.mdpi.com/2075-4426/12/4/546 |
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