Age‐dependent effects of diabetes and obesity on liver‐related events in non‐alcoholic fatty liver disease: Subanalysis of CLIONE in Asia

• Published in: Journal of gastroenterology and hepatology Vol. 37; no. 12; pp. 2313 - 2320
• Main Authors: Seko, Yuya, Kawanaka, Miwa, Fujii, Hideki, Iwaki, Michihiro, Hayashi, Hideki, Toyoda, Hidenori, Oeda, Satoshi, Hyogo, Hideyuki, Morishita, Asahiro, Munekage, Kensuke, Kawata, Kazuhito, Yamamura, Sakura, Sawada, Koji, Maeshiro, Tatsuji, Tobita, Hiroshi, Yoshida, Yuichi, Naito, Masafumi, Araki, Asuka, Arakaki, Shingo, Kawaguchi, Takumi, Noritake, Hidenao, Ono, Masafumi, Masaki, Tsutomu, Yasuda, Satoshi, Tomita, Eiichi, Yoneda, Masato, Tokushige, Akihiro, Kamada, Yoshihiro, Takahashi, Hirokazu, Ueda, Shinichiro, Aishima, Shinichi, Sumida, Yoshio, Okanoue, Takeshi, Itoh, Yoshito, Nakajima, Atsushi
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.12.2022
• Subjects: Age; Biopsy; BMI; Body mass index; CLIONE in Asia; Diabetes; Diabetes mellitus (non-insulin dependent); Fatty liver; Fibrosis; Hepatocellular carcinoma; Liver cancer; Liver diseases; liver‐related events; non‐alcoholic fatty liver disease; non‐alcoholic steatohepatitis; Obesity; Risk factors; type 2 diabetes mellitus; Asia; CLIONE in Asia; non-alcoholic fatty liver disease; type 2 diabetes mellitus; liver-related events; fibrosis; age; hepatocellular carcinoma; obesity; BMI; non-alcoholic steatohepatitis
• ISSN: 0815-9319; 1440-1746; 1440-1746
• DOI: 10.1111/jgh.16019

Background and Aim Older age, type 2 diabetes mellitus (T2DM), and obesity are known risk factors for liver‐related events (LREs). We investigated the impacts of T2DM and obesity on LRE according to age in Japanese patients with non‐alcoholic fatty liver disease (NAFLD). Methods We performed a subanalysis of a retrospective cohort study (CLIONE in Asia), including 1395 patients with biopsy‐proven NAFLD. The median follow‐up was 4.6 years. Results The median age was 57 years, and 36.2% had T2DM. The median body mass index (BMI) was 27.4, and 28.5% were severely obese (BMI ≥ 30). During follow‐up, 37 patients developed hepatocellular carcinoma (HCC), and 58 patients developed LRE. In patients younger than 65 years, advanced fibrosis (hazard ratio [HR] 7.69, P < 0.001) and T2DM (HR 3.37, P = 0.017) were HCC risk factors, and advanced fibrosis (HR 9.40, P < 0.001) and T2DM (HR 2.51, P = 0.016) were LRE risk factors. In patients 65 years and older, advanced fibrosis (HR 4.24, P = 0.010) and obesity (HR 4.60, P = 0.006) were HCC risk factors, and advanced fibrosis (HR 4.22, P = 0.002) and obesity (HR 4.22, P = 0.002) were LRE risk factors. Conclusion Type 2 diabetes mellitus and obesity contributed to LRE in younger and older patients, respectively, along with advanced fibrosis. Therefore, controlling T2DM in patients younger than 65 years and controlling weight in patients 65 years and older could prevent LRE. The development of age‐dependent screening and management strategies is necessary for patients with NAFLD.