Impact of steatotic liver disease categories on atrial fibrillation in type 2 diabetes: a nationwide study

Abstract This study aims to investigate the incidence of new-onset atrial fibrillation (AF) in individuals with type 2 diabetes mellitus (T2DM) across different categories of steatotic liver disease (SLD). Using a health examination database between 2009 and 2012, this study included 2,480,880 patie...

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Main Authors: So Hyun Cho, Gyuri Kim, Kyu-na Lee, Rosa Oh, Ji Yoon Kim, Myunghwa Jang, You-Bin Lee, Sang-Man Jin, Kyu Yeon Hur, Kyungdo Han, Jae Hyeon Kim
Format: Article
Language:English
Published: Nature Portfolio 2025-04-01
Series:Scientific Reports
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Online Access:https://doi.org/10.1038/s41598-025-94783-8
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author So Hyun Cho
Gyuri Kim
Kyu-na Lee
Rosa Oh
Ji Yoon Kim
Myunghwa Jang
You-Bin Lee
Sang-Man Jin
Kyu Yeon Hur
Kyungdo Han
Jae Hyeon Kim
author_facet So Hyun Cho
Gyuri Kim
Kyu-na Lee
Rosa Oh
Ji Yoon Kim
Myunghwa Jang
You-Bin Lee
Sang-Man Jin
Kyu Yeon Hur
Kyungdo Han
Jae Hyeon Kim
author_sort So Hyun Cho
collection DOAJ
description Abstract This study aims to investigate the incidence of new-onset atrial fibrillation (AF) in individuals with type 2 diabetes mellitus (T2DM) across different categories of steatotic liver disease (SLD). Using a health examination database between 2009 and 2012, this study included 2,480,880 patients. Participants were categorized into five groups based on hepatic steatosis (fatty liver index ≥ 60), cardiometabolic risk factors, and alcohol consumption. Cox regression analyses were performed. The metabolic dysfunction-associated steatotic liver disease (MASLD) group showed an increased risk of new-onset AF (adjusted hazard ratio (aHR), 1.10; 95% confidence interval (CI), 1.08–1.11). The MASLD with other combined group demonstrated increased AF development (aHR, 1.22; 95% CI, 1.18–1.26). In metabolic dysfunction and alcohol-related steatotic liver disease (MetALD) and alcohol-related liver disease (ALD) with metabolic groups, heavy to excessive alcohol consumption increased the risk of AF incidence, with the highest aHR associated with greater alcohol intake (aHR, 1.26; 95% CI, 1.22–1.29, 1.48; 95% CI, 1.41–1.55). MASLD increased the risk of AF in patients with T2DM, with a higher risk observed when accompanied by other liver diseases. Alcohol consumption was associated with proportional increase in the risk of AF, with excessive alcohol consumption associated with the highest risk of AF.
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spelling doaj-art-61b2f10ba4c840e9a3c0c351c88096f22025-08-20T02:25:40ZengNature PortfolioScientific Reports2045-23222025-04-0115111010.1038/s41598-025-94783-8Impact of steatotic liver disease categories on atrial fibrillation in type 2 diabetes: a nationwide studySo Hyun Cho0Gyuri Kim1Kyu-na Lee2Rosa Oh3Ji Yoon Kim4Myunghwa Jang5You-Bin Lee6Sang-Man Jin7Kyu Yeon Hur8Kyungdo Han9Jae Hyeon Kim10Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Biomedicine & Health Sciences, College of Medicine, The Catholic University of KoreaDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Statistics and Actuarial Science, Soongsil UniversityDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineAbstract This study aims to investigate the incidence of new-onset atrial fibrillation (AF) in individuals with type 2 diabetes mellitus (T2DM) across different categories of steatotic liver disease (SLD). Using a health examination database between 2009 and 2012, this study included 2,480,880 patients. Participants were categorized into five groups based on hepatic steatosis (fatty liver index ≥ 60), cardiometabolic risk factors, and alcohol consumption. Cox regression analyses were performed. The metabolic dysfunction-associated steatotic liver disease (MASLD) group showed an increased risk of new-onset AF (adjusted hazard ratio (aHR), 1.10; 95% confidence interval (CI), 1.08–1.11). The MASLD with other combined group demonstrated increased AF development (aHR, 1.22; 95% CI, 1.18–1.26). In metabolic dysfunction and alcohol-related steatotic liver disease (MetALD) and alcohol-related liver disease (ALD) with metabolic groups, heavy to excessive alcohol consumption increased the risk of AF incidence, with the highest aHR associated with greater alcohol intake (aHR, 1.26; 95% CI, 1.22–1.29, 1.48; 95% CI, 1.41–1.55). MASLD increased the risk of AF in patients with T2DM, with a higher risk observed when accompanied by other liver diseases. Alcohol consumption was associated with proportional increase in the risk of AF, with excessive alcohol consumption associated with the highest risk of AF.https://doi.org/10.1038/s41598-025-94783-8Alcohol consumptionAtrial fibrillationDiabetesFatty liver indexMetabolic dysfunction-associated steatotic liver disease
spellingShingle So Hyun Cho
Gyuri Kim
Kyu-na Lee
Rosa Oh
Ji Yoon Kim
Myunghwa Jang
You-Bin Lee
Sang-Man Jin
Kyu Yeon Hur
Kyungdo Han
Jae Hyeon Kim
Impact of steatotic liver disease categories on atrial fibrillation in type 2 diabetes: a nationwide study
Scientific Reports
Alcohol consumption
Atrial fibrillation
Diabetes
Fatty liver index
Metabolic dysfunction-associated steatotic liver disease
title Impact of steatotic liver disease categories on atrial fibrillation in type 2 diabetes: a nationwide study
title_full Impact of steatotic liver disease categories on atrial fibrillation in type 2 diabetes: a nationwide study
title_fullStr Impact of steatotic liver disease categories on atrial fibrillation in type 2 diabetes: a nationwide study
title_full_unstemmed Impact of steatotic liver disease categories on atrial fibrillation in type 2 diabetes: a nationwide study
title_short Impact of steatotic liver disease categories on atrial fibrillation in type 2 diabetes: a nationwide study
title_sort impact of steatotic liver disease categories on atrial fibrillation in type 2 diabetes a nationwide study
topic Alcohol consumption
Atrial fibrillation
Diabetes
Fatty liver index
Metabolic dysfunction-associated steatotic liver disease
url https://doi.org/10.1038/s41598-025-94783-8
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