Objective To investigate the risk of non-alcoholic fatty liver disease (NAFLD) for cardiovascular disease and all cause death in patients with type 2 diabetes mellitus (T2DM). Design Nationwide population based study. Setting Longitudinal cohort study in Korea. Participants 7 796 763 participants in the National Health Screening Programme in 2009 were divided into three groups based on NAFLD status: no NAFLD (fatty liver index<30); grade 1 NAFLD (30≤fatty liver index<60); and grade 2 NAFLD (fatty liver index≥60). Median follow-up was 8.13 years. Main outcome measures The primary outcome was incident cardiovascular disease (myocardial infarction, ischaemic stroke) or all cause death. Results Of 7 796 763 participants, 6.49% (n=505 763) had T2DM. More patients with T2DM had grade 1 NAFLD (34.06%) and grade 2 NAFLD (26.73%) than those without T2DM (grade 1 NAFLD: 21.20%; grade 2 NAFLD: 10.02%). The incidence rate (per 1000 person years) of cardiovascular disease and all cause death increased in the order of no NAFLD, grade 1 NAFLD, and grade 2 NAFLD, and the incidence rates in patients with T2DM were higher than those in patients without T2DM. The five year absolute risk for cardiovascular disease and all cause death increased in the order of no NAFLD, grade 1 NAFLD, and grade 2 NAFLD in patients without and with T2DM (no NAFLD, without T2DM: 1.03, 95% confidence interval 1.02 to 1.04, and 1.25, 1.24 to 1.26, respectively; grade 1 NAFLD, without T2DM: 1.23, 1.22 to 1.25, and 1.50, 1.48 to 1.51, respectively; grade 2 NAFLD, without T2DM: 1.42, 1.40 to 1.45, and 2.09, 2.06 to 2.12, respectively; no NAFLD, with T2DM: 3.34, 3.27 to 3.41, and 3.68, 3.61 to 3.74, respectively; grade 1 NAFLD, with T2DM: 3.94, 3.87 to 4.02, and 4.25, 4.18 to 4.33, respectively; grade 2 NAFLD, with T2DM: 4.66, 4.54 to 4.78, and 5.91, 5.78 to 6.05, respectively). Patients with T2DM and without NAFLD had a higher five year absolute risk for cardiovascular disease and all cause death than those without T2DM and with grade 2 NAFLD. Risk differences for cardiovascular disease and all cause death between no NAFLD and grade 1 or grade 2 NAFLD were higher in patients with T2DM than in those without T2DM. Conclusions NAFLD in patients with T2DM seems to be associated with a higher risk of cardiovascular disease and all cause death, even in patients with mild NAFLD. Risk differences for cardiovascular disease and all cause death between the no NAFLD group and the grade 1 or grade 2 NAFLD groups were higher in patients with T2DM than in those without T2DM. Additional data are available through approval and oversight by the Korean National Health Insurance Service.

中文翻译：

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非酒精性脂肪肝与 2 型糖尿病患者心血管疾病及所有死亡原因的关联：全国人群研究


目的 探讨2型糖尿病（T2DM）患者非酒精性脂肪性肝病（NAFLD）导致心血管疾病和全因死亡的风险。设计基于全国人口的研究。在韩国进行纵向队列研究。参与者 2009年全国健康筛查计划的7 796 763名参与者根据NAFLD状况分为三组：无NAFLD（脂肪肝指数<30）；无NAFLD（脂肪肝指数<30）； 1级NAFLD（30≤脂肪肝指数<60）； 2级NAFLD（脂肪肝指数≥60）。中位随访时间为 8.13 年。主要结局指标 主要结局是心血管疾病事件（心肌梗死、缺血性中风）或全因死亡。结果 在 7 796 763 名参与者中，6.49% (n=505 763) 患有 T2DM。与非 T2DM 患者相比，患有 1 级 NAFLD（34.06%）和 2 级 NAFLD（26.73%）的 T2DM 患者较多（1 级 NAFLD：21.20%；2 级 NAFLD：10.02%）。心血管疾病和全因死亡的发病率（每1000人年）按无NAFLD、1级NAFLD、2级NAFLD的顺序升高，且T2DM患者的发病率高于非T2DM患者。在不患有和患有 T2DM 的患者中，心血管疾病和全因死亡的五年绝对风险按照无 NAFLD、1 级 NAFLD 和 2 级 NAFLD 的顺序增加（无 NAFLD、无 T2DM：1.03，95% 置信区间 1.02 至 1.04 、1.25、1.24 至 1.26；1 级 NAFLD，无 T2DM：分别为 1.23、1.22 至 1.25 和 1.50、1.48 至 1.51；2 级 NAFLD，无 T2DM：1.42、1.40 至 1.45 和 2.09、2.06 2.12，无 NAFLD，伴 T2DM：分别为 3.34、3.27 至 3.41 和 3.68、3.61 至 3.74；1 级 NAFLD，伴 T2DM：3.94、3.87 至 4.02 和 4.25、4.18 至 4。分别为 33 个； 2 级 NAFLD，合并 T2DM：分别为 4.66、4.54 至 4.78 和 5.91、5.78 至 6.05）。与非 T2DM 和 2 级 NAFLD 患者相比，患有 T2DM 且无 NAFLD 的患者患心血管疾病和所有原因死亡的五年绝对风险较高。 T2DM 患者中无 NAFLD 与 1 级或 2 级 NAFLD 之间心血管疾病和全因死亡的风险差异高于非 T2DM 患者。结论 T2DM 患者的 NAFLD 似乎与心血管疾病和所有死亡风险较高相关，即使是轻度 NAFLD 患者也是如此。 T2DM 患者中，无 NAFLD 组与 1 级或 2 级 NAFLD 组之间心血管疾病和全因死亡的风险差异高于非 T2DM 患者。其他数据可通过韩国国民健康保险局的批准和监督获得。