ABSTRACT
Objective:To investigate the association of surrogate indexes of insulin resistance with the risk of nonalcoholic fatty liver disease(NAFLD)and advanced liver fibrosis in newly diagnosed patients with type 2 mellitus.Methods:A total of 429 newly diagnosed type 2 diabetic patients hospitalized in the Department of Endocrinology and Metabolism, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine from June 2018 to June 2020 were included. The patients were divided into NAFLD group( n=263)and non-NAFLD group( n=166)according to the results of abdominal ultrasound, NAFLD patients were divided into advanced liver fibrosis group( n=33)and non-advanced liver fibrosis group( n=230)according to the NAFLD fibrosis score(NFS). The correlation of the triglyceride/high density lipoprotein-cholesterol ratio(TG/HDL-C), triglyceride glucose index(TyG), visceral adiposity index(VAI), triglyceride glucose-body mass index(TyG-BMI), homeostasis model assessment of insulin resistance index(HOMA-IR)with NAFLD and the occurrence of advanced liver fibrosis were analyzed. Results:The prevalence of NAFLD in newly diagnosed type 2 diabetic patients was 61.3%, and the prevalence of advanced liver fibrosis was 12.5%. After adjusting the potential confounders, multivariate logistic regression analysis showed that TG/HDL-C, TyG, VAI, TyG-BMI, and HOMA-IR were independently and positively correlated with NAFLD, and only TyG-BMI was independently and positively correlated with advanced liver fibrosis( OR=1.021, 95% CI 1.009-1.034, P<0.01). The receiver operating characteristic analysis showed that the area under the curue of TyG-BMI was more than those of TG/HDL-C, TyG, VAI and HOMA-IR for predicting the occurrence of NAFLD in newly diagnosed type 2 diabetic patients(0.83 vs 0.73, 0.74, 0.73, 0.67, P<0.01), but had no predictive value for advanced liver fibrosis. Conclusion:TyG-BMI is superior to TG/HDL-C, TyG, VAI and HOMA-IR for predicting the occurrence of NAFLD in newly diagnosed type 2 diabetic patients, and it is also an independent risk factor for advanced liver fibrosis.
ABSTRACT
Objective To investigate the relationship between serum 25-hydroxyvitamin D [25(OH)D] level and the risk of metabolic syndrome ( MS) and its components in patients with type 2 diabetes mellitus. Methods Clinical data of 796 type 2 diabetic inpatients in the Department of Endocrinology, the Ninth People' s Hospital, Shanghai Jiaotong University School of Medicine, from January 2017 to December 2018 were enrolled. These patients were divided into MS group (n=541) and non-MS group (n=255). The association of serum vitamin D level and metabolic syndrome was investigated. Results The level of 25( OH) D in MS group was significantly lower than that in non-MS group (P<0.05). According to 25(OH)D 20 ng/ml as the borderline of vitamin D deficiency, the rate of 25(OH)D deficiency in MS group was significantly higher than that in non-MS group (P<0.01). Serum 25(OH)D levels in patients with type 2 diabetes were negatively correlated with smoking, body mass index, systolic blood pressure, diastolic blood pressure, waist circumference, triglyceride, and low density lipoprotein-cholesterol levels ( all P<0.05) . Multiple logistic regression analysis showed that 25( OH) D was an independent protective factor for MS in patients with type 2 diabetes. These patients were divided into 4 subgroups according to 25( OH) D levels [ Q1:0-10 ng/ml (n=24), Q2:10-20 ng/ml (n=417), Q3:20-30 ng/ml (n=117), Q4≥30 ng/ml(n=18)]. Logistic regression showed that the risk ratios (OR) of the metabolic syndrome in the Q2, Q3, and Q4 groups were 0.471, 0.389, and 0.211 respectively, compared with Q1 group (P<0.05).Conclusion Serum 25(OH)D level in type 2 diabetic patients was negatively correlated with the risk of MS.