Combined impact of prediabetes and fatty liver index on cardiometabolic outcomes and mortality in middle aged adults: a nationwide cohort study
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, a...
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| Published in | Cardiovascular diabetology Vol. 24; no. 1; pp. 279 - 11 |
|---|---|
| Main Authors | , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
London
BioMed Central
10.07.2025
BMC |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1475-2840 1475-2840 |
| DOI | 10.1186/s12933-025-02793-7 |
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| 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 |
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| AbstractList | 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.
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.
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.
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.
Not applicable (retrospectively registered). BackgroundTo 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.MethodsA 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.ResultsAmong 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.ConclusionThe 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 registrationNot applicable (retrospectively registered). 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 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 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.BACKGROUNDTo 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.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.METHODSA 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.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.RESULTSAmong 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.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.CONCLUSIONThe 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.Not applicable (retrospectively registered).TRIAL REGISTRATIONNot applicable (retrospectively registered). |
| ArticleNumber | 279 |
| Author | Kim, Jin Hwa Kang, Ho-Cheol Jeong, Seogsong Park, Minae Yoon, Youngmin Park, Ji Yong Kim, Sang Yong Yoon, Jee Hee Hong, A Ram Choi, Wonsuk Lyu, Young Sang Park, Sojeong Kim, Hee Kyung |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/40640818$$D View this record in MEDLINE/PubMed |
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To investigate the combined effect of prediabetes and fatty liver index on incident diabetes (DM), major adverse cardiovascular events (MACE), and... To investigate the combined effect of prediabetes and fatty liver index on incident diabetes (DM), major adverse cardiovascular events (MACE), and mortality in... BackgroundTo investigate the combined effect of prediabetes and fatty liver index on incident diabetes (DM), major adverse cardiovascular events (MACE), and... Abstract Background To investigate the combined effect of prediabetes and fatty liver index on incident diabetes (DM), major adverse cardiovascular events... |
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| SubjectTerms | Adult Age Factors Aged Angiology Biomarkers - blood Body mass index Cardiology Cardiometabolic disease Cardiometabolic Risk Factors Cardiovascular diseases Cardiovascular Diseases - diagnosis Cardiovascular Diseases - epidemiology Cardiovascular Diseases - mortality Cause of Death Cohort study Diabetes Diabetes mellitus Diabetes Mellitus - diagnosis Diabetes Mellitus - epidemiology Diabetes Mellitus - mortality Exercise Fatty liver Female Hepatic steatosis Humans Incidence Kidney diseases Male Medicine Medicine & Public Health Middle Aged Middle-aged adult Mortality Non-alcoholic Fatty Liver Disease - diagnosis Non-alcoholic Fatty Liver Disease - mortality Prediabetes Prediabetic State - blood Prediabetic State - diagnosis Prediabetic State - epidemiology Prediabetic State - mortality Prognosis Risk Assessment Risk Factors Steatosis Time Factors |
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| Title | Combined impact of prediabetes and fatty liver index on cardiometabolic outcomes and mortality in middle aged adults: a nationwide cohort study |
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