Non-alcoholic fatty liver disease and the risk of insulin-requiring gestational diabetes
NAFLD is characterized by excessive fat stored in hepatocytes. The occurrence of NAFLD is directly related to that of obesity, Metabolic Syndrome (MetS) and T2DM since they share a common metabolic dysfunction of IR. Studies have shown association between GDM and NAFLD in women. Hence Sang Youn You and colleagues conducted population-based study titled “Non-alcoholic fatty liver disease and the risk of insulin-requiring gestational diabetes” published in BMC Diabetology & Metabolic Syndrome Journal
Objective:
To examine prognostic relevance of NAFLD before pregnancy for the risk of severe GDM.
Methods:
Retrospective recruitment using NHIS database (2011-2015). Insulin-requiring GDM was defined as no insurance claims for diabetes mellitus and a fasting blood glucose level of < 126 mg/dL before pregnancy, and initiation of insulin treatment during pregnancy. A fatty liver index (FLI) was calculated using body mass index, waist circumference, and blood triglyceride and γ-glutamyl transferase levels. FLI scores < 30 ruled out hepatic steatosis, while FLI scores ≥ 60 indicated NAFLD.
Findings :
The existing studies linking NAFLD and the risk of GDM did not regard the MetS status of the subjects. This study identified a well-built linkage among women without MetS before pregnancy, which reinforce the hypothesis that NAFLD is an independent risk factor for GDM, regardless of MetS status. The (Fatty Liver Index) FLI is a multivariate model used to estimate fat accumulation in the liver and was thus found to be associated with risk of GDM in a dose dependent manner. NAFLD in women is an independent risk factor for insulin-requiring GDM.
Limitations:
First,No histological examination and liver ultrasound was performed to diagnose NAFLD. Second, no full proof evidence to verify the validity of the FLI in the Korean population. Third, no data on transient elastography (TE) or acoustic radiation force impulse (ARFI). Fourth, no data studied on IR such as HOMA-IR. Finally, the study is limited to Korean population.
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