Relative Risk of Nonalcoholic Fatty Liver Disease between Women and Men according to Glycemic Status

Background: Nonalcoholic fatty liver disease (NAFLD) is closely associated with type 2 diabetes (T2D). However, there is no current study for NAFLD risk stratification by sex and glycemic status. We investigated whether different glycemic status may interfere with metabolic effects affecting NAFLD according to sex. Methods: A total of 552 patients with normal glucose tolerance (NGT), prediabetes, and diabetes, were evaluated for odds ratio (OR) and hazard ratio (HR) for NAFLD (above steatosis stage 1) in cross-sectional and longitudinal study, respectively. Univariate analyses and subgroup analyses were performed to determine the risk factors for developing NAFLD according to sex and glycemic status. Hepatic steatosis and fibrosis were determined using transient elastography and body composition was analyzed by Inbody. Results: In cross-sectional study, men with prediabetes and diabetes exhibited greater relative differences in metabolic syndrome, triglyceride and HDL cholesterol than women with prediabetes and diabetes when compared with their NGT counterparts. There was no difference in OR for NAFLD observed comparing women and men with prediabetes or diabetes. After 2.6 years of follow up, we found that women with prediabetes showed significantly increased HR (HR 1.81; 95% CI 1.01-3.26; p = 0.049) of NAFLD than men with prediabetes (HR 0.83; 95% CI 0.54-1.30; p =0.42), even after adjusting several confounders. Visceral fat area was significantly higher in women with prediabetes and diabetes compared to men throughout the study. Insulin resistance (HOMA-IR≥2.5) was prediabetes-specific risk factor, contributing for prevalent NAFLD (OR 6.56; 95% CI 1.15-37.31; p=0.034) without interaction between sex and insulin resistance (p=0.99). Conclusions: Women with prediabetes showed higher risk for developing NAFLD compared to men due to greater burden of metabolic dysregulation between adipose tissue and insulin resistance. Disclosure H.Kim: None. S.Lee: None. M.Lee: None. Y.Lee: None. E.Kang: None. B.Cha: None.