Combined impact of prediabetes and fatty liver index on cardiometabolic outcomes and mortality in middle aged adults: a nationwide cohort study
Abstract Background To investigate the combined effect of prediabetes and fatty liver index on incident diabetes (DM), major adverse cardiovascular events (MACE), and mortality in middle-aged adults. Methods A nationwide cohort study was conducted involving 1,182,751 middle-aged adults aged 40 to 65...
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BMC
2025-07-01
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| Series: | Cardiovascular Diabetology |
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| Online Access: | https://doi.org/10.1186/s12933-025-02793-7 |
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| author | Young Sang Lyu Minae Park Hee Kyung Kim Sojeong Park Ji Yong Park A Ram Hong Jee Hee Yoon Seogsong Jeong Youngmin Yoon Jin Hwa Kim Sang Yong Kim Ho-Cheol Kang Wonsuk Choi |
| author_facet | Young Sang Lyu Minae Park Hee Kyung Kim Sojeong Park Ji Yong Park A Ram Hong Jee Hee Yoon Seogsong Jeong Youngmin Yoon Jin Hwa Kim Sang Yong Kim Ho-Cheol Kang Wonsuk Choi |
| author_sort | Young Sang Lyu |
| collection | DOAJ |
| description | Abstract Background To investigate the combined effect of prediabetes and fatty liver index on incident diabetes (DM), major adverse cardiovascular events (MACE), and mortality in middle-aged adults. Methods A nationwide cohort study was conducted involving 1,182,751 middle-aged adults aged 40 to 65 years, all of whom had no history of diabetes or cardiovascular disease. The primary outcomes of our study included incident DM, composite MACE and all-cause mortality. Results Among the participants, 24.6% were diagnosed with prediabetes, while 8.8% had FLI ≥ 60 at baseline. Both conditions independently increased the risk of incident DM, composite MACE, and all-cause mortality. Stratification based on the presence of prediabetes and FLI ≥ 60 showed that their combination posed the highest risk for outcomes, even after adjusting for relevant covariates. For incident DM, the odds ratios (ORs) with 95% confidence intervals (CI) were as follows: 3.75 (3.69–3.81), 2.35 (2.29–2.42), and 6.80 (6.62–6.98) for prediabetes with FLI < 60, normoglycemia with FLI ≥ 60, and prediabetes with FLI ≥ 60, respectively. For composite MACE, the ORs (95% CI) were 1.02 (1.00–1.05), 1.23 (1.17–1.28), and 1.27 (1.21–1.33) for prediabetes with FLI < 60, normoglycemia with FLI ≥ 60, and prediabetes with FLI ≥ 60, respectively. For all-cause mortality, ORs (95% CI) were 1.12 (1.08–1.15), 1.51 (1.43–1.59), and 1.69 (1.60–1.79) for prediabetes with FLI < 60, normoglycemia with FLI ≥ 60, and prediabetes with FLI ≥ 60, respectively. Conclusion The coexistence of prediabetes and FLI ≥ 60, which is a surrogate marker of hepatic steatosis, demonstrated a combined effect, additively increasing the risk of incident DM, composite MACE, and all-cause mortality in middle-aged adults. Trial registration Not applicable (retrospectively registered). Graphical abstract |
| format | Article |
| id | doaj-art-42f28337c2cf41ac8561e4f8d9a81a50 |
| institution | Kabale University |
| issn | 1475-2840 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj-art-42f28337c2cf41ac8561e4f8d9a81a502025-08-20T03:42:44ZengBMCCardiovascular Diabetology1475-28402025-07-0124111110.1186/s12933-025-02793-7Combined impact of prediabetes and fatty liver index on cardiometabolic outcomes and mortality in middle aged adults: a nationwide cohort studyYoung Sang Lyu0Minae Park1Hee Kyung Kim2Sojeong Park3Ji Yong Park4A Ram Hong5Jee Hee Yoon6Seogsong Jeong7Youngmin Yoon8Jin Hwa Kim9Sang Yong Kim10Ho-Cheol Kang11Wonsuk Choi12Division of Endocrinology and Metabolism, Department of Internal Medicine, Chosun University HospitalData Science Team, Hanmi Pharm. Co., Ltd.Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical SchoolData Science Team, Hanmi Pharm. Co., Ltd.Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical SchoolDepartment of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical SchoolDepartment of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical SchoolDepartment of Biomedical Informatics, Korea University College of MedicineDivision of Nephrology, Department of Medicine, Chosun University Hospital, Chosun University School of MedicineDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chosun University HospitalDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chosun University HospitalDepartment of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical SchoolDepartment of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical SchoolAbstract Background To investigate the combined effect of prediabetes and fatty liver index on incident diabetes (DM), major adverse cardiovascular events (MACE), and mortality in middle-aged adults. Methods A nationwide cohort study was conducted involving 1,182,751 middle-aged adults aged 40 to 65 years, all of whom had no history of diabetes or cardiovascular disease. The primary outcomes of our study included incident DM, composite MACE and all-cause mortality. Results Among the participants, 24.6% were diagnosed with prediabetes, while 8.8% had FLI ≥ 60 at baseline. Both conditions independently increased the risk of incident DM, composite MACE, and all-cause mortality. Stratification based on the presence of prediabetes and FLI ≥ 60 showed that their combination posed the highest risk for outcomes, even after adjusting for relevant covariates. For incident DM, the odds ratios (ORs) with 95% confidence intervals (CI) were as follows: 3.75 (3.69–3.81), 2.35 (2.29–2.42), and 6.80 (6.62–6.98) for prediabetes with FLI < 60, normoglycemia with FLI ≥ 60, and prediabetes with FLI ≥ 60, respectively. For composite MACE, the ORs (95% CI) were 1.02 (1.00–1.05), 1.23 (1.17–1.28), and 1.27 (1.21–1.33) for prediabetes with FLI < 60, normoglycemia with FLI ≥ 60, and prediabetes with FLI ≥ 60, respectively. For all-cause mortality, ORs (95% CI) were 1.12 (1.08–1.15), 1.51 (1.43–1.59), and 1.69 (1.60–1.79) for prediabetes with FLI < 60, normoglycemia with FLI ≥ 60, and prediabetes with FLI ≥ 60, respectively. Conclusion The coexistence of prediabetes and FLI ≥ 60, which is a surrogate marker of hepatic steatosis, demonstrated a combined effect, additively increasing the risk of incident DM, composite MACE, and all-cause mortality in middle-aged adults. Trial registration Not applicable (retrospectively registered). Graphical abstracthttps://doi.org/10.1186/s12933-025-02793-7PrediabetesHepatic steatosisMiddle-aged adultCardiometabolic diseaseCohort study |
| spellingShingle | Young Sang Lyu Minae Park Hee Kyung Kim Sojeong Park Ji Yong Park A Ram Hong Jee Hee Yoon Seogsong Jeong Youngmin Yoon Jin Hwa Kim Sang Yong Kim Ho-Cheol Kang Wonsuk Choi Combined impact of prediabetes and fatty liver index on cardiometabolic outcomes and mortality in middle aged adults: a nationwide cohort study Cardiovascular Diabetology Prediabetes Hepatic steatosis Middle-aged adult Cardiometabolic disease Cohort study |
| title | Combined impact of prediabetes and fatty liver index on cardiometabolic outcomes and mortality in middle aged adults: a nationwide cohort study |
| title_full | Combined impact of prediabetes and fatty liver index on cardiometabolic outcomes and mortality in middle aged adults: a nationwide cohort study |
| title_fullStr | Combined impact of prediabetes and fatty liver index on cardiometabolic outcomes and mortality in middle aged adults: a nationwide cohort study |
| title_full_unstemmed | Combined impact of prediabetes and fatty liver index on cardiometabolic outcomes and mortality in middle aged adults: a nationwide cohort study |
| title_short | Combined impact of prediabetes and fatty liver index on cardiometabolic outcomes and mortality in middle aged adults: a nationwide cohort study |
| title_sort | combined impact of prediabetes and fatty liver index on cardiometabolic outcomes and mortality in middle aged adults a nationwide cohort study |
| topic | Prediabetes Hepatic steatosis Middle-aged adult Cardiometabolic disease Cohort study |
| url | https://doi.org/10.1186/s12933-025-02793-7 |
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