Comparing diabetes prediction based on metabolic dysfunction-associated steatotic liver disease and nonalcoholic fatty liver disease: the ELSA-Brasil study

• Published in: Cadernos de saúde pública 2024-01, Vol.40 (11), p.e00009924
• Main Authors: Lopes, Gabriela Wünsch, Canhada, Scheine Leite, Reis, Rodrigo Citton Padilha Dos, Diniz, Maria de Fátima Haueisen Sander, Goulart, Alessandra Carvalho, Faria, Luciana Costa, Griep, Rosane Harter, Perazzo, Hugo, Duncan, Bruce Bartholow, Schmidt, Maria Inês
• Format: Article
• Language: English
• Subjects: Adult; Aged; Brazil - epidemiology; Diabetes Mellitus, Type 2 - complications; Ethnicity; Female; Humans; Incidence; Longitudinal Studies; Male; Middle Aged; Non-Alcoholic Fatty Liver Disease; Non-alcoholic Fatty Liver Disease - complications; Non-alcoholic Fatty Liver Disease - epidemiology; Prospective Studies; PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH; Risk Factors; Type 2 Diabetes Mellitus
• ISSN: 0102-311X; 1678-4464; 1678-4464
• DOI: 10.1590/0102-311XEN009924

We aimed to compare nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) definitions concerning diabetes prediction in a large sample of Brazilian adults. As a secondary objective, we compared associations between NAFLD/MASLD and diabetes across self-declared race/skin color groups. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study of Brazilian civil servants (35-74 years) enrolled from 2008 to 2010 and followed up from 2012-2014 and 2017-2019. We ascertained type 2 diabetes mellitus at baseline as well as follow-up visits based on self-reported diagnosis, medication use, and glycemic tests (fasting and 2h post-OGTT glucose and HbA1c). We excluded individuals with heavy alcohol consumption or self-reported cirrhosis/hepatitis. We analyzed 7,073 subjects. NAFLD was defined by ultrasound-based steatosis. Participants with steatosis and at least one cardiometabolic factor were considered as having MASLD. Cox proportional hazards models were performed to evaluate the association between NAFLD/MASLD and the incidence of type 2 diabetes mellitus. At baseline, 33.9% of individuals presented NAFLD and 32.5% presented MASLD. Over 9.4 years of follow-up, the relative increase in the incidence of diabetes was 78% for NAFLD (HR = 1.78; 95%CI: 1.58-2.01) and 88% for MASLD (HR = 1.88; 95%CI: 1.67-2.12). Associations did not differ significantly among race/skin color groups (p for interaction = 0.10 for MASLD and 0.08 for NAFLD). In this large cohort of middle-aged and older Brazilian adults, the relative incidence of diabetes was similar for NAFLD and MASLD definitions, with similar associations in all ethnic groups.