Non-alcoholic fatty liver disease (NAFLD), identified by the Fatty Liver Index (FLI), is associated with increased mortality and cardiovascular (CV) outcomes. Whether this also applies to type 1 diabetes (T1D) has not been yet reported. We prospectively observed 774 subjects with type 1 diabetes (males 52%, 30.3 ± 11.1 years old, diabetes duration (DD) 18.5 ± 11.6 years, HbA1c 7.8 ± 1.2%) to assess the associations between FLI (based on BMI, waist circumference, gamma-glutamyl transferase and triglycerides) and all-cause death and first CV events. Over a median 11-year follow-up, 57 subjects died (7.4%) and 49 CV events (6.7%) occurred among 736 individuals with retrievable incidence data. At baseline, FLI was < 30 in 515 subjects (66.5%), 30–59 in 169 (21.8%), and ≥ 60 in 90 (11.6%). Mortality increased steeply with FLI: 3.9, 10.1, 22.2% (p < 0.0001). In unadjusted Cox analysis, compared to FLI < 30, risk of death increased in FLI 30–59 (HR 2.85, 95% CI 1.49–5.45, p = 0.002) and FLI ≥ 60 (6.07, 3.27–11.29, p < 0.0001). Adjusting for Steno Type 1 Risk Engine (ST1-RE; based on age, sex, DD, systolic BP, LDL cholesterol, HbA1c, albuminuria, eGFR, smoking and exercise), HR was 1.52 (0.78–2.97) for FLI 30–59 and 3.04 (1.59–5.82, p = 0.001) for FLI ≥ 60. Inclusion of prior CV events slightly modified HRs. FLI impact was confirmed upon adjustment for EURODIAB Risk Engine (EURO-RE; based on age, HbA1c, waist-to-hip ratio, albuminuria and HDL cholesterol): FLI 30–59: HR 1.24, 0.62–2.48; FLI ≥ 60: 2.54, 1.30–4.95, p = 0.007), even after inclusion of prior CVD. CV events incidence increased with FLI: 3.5, 10.5, 17.2% (p < 0.0001). In unadjusted Cox, HR was 3.24 (1.65–6.34, p = 0.001) for FLI 30–59 and 5.41 (2.70–10.83, p < 0.0001) for FLI ≥ 60. After adjustment for ST1-RE or EURO-RE, FLI ≥ 60 remained statistically associated with risk of incident CV events, with trivial modification with prior CVD inclusion. This observational prospective study shows that FLI is associated with higher all-cause mortality and increased risk of incident CV events in type 1 diabetes.

中文翻译：

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脂肪肝指数是 1 型糖尿病全因死亡率和主要心血管事件的独立危险因素：一项为期 11 年的观察性研究

通过脂肪肝指数 (FLI) 确定的非酒精性脂肪肝 (NAFLD) 与死亡率和心血管 (CV) 结局增加相关。这是否也适用于 1 型糖尿病 (T1D) 尚未有报道。我们前瞻性观察了 774 名 1 型糖尿病受试者（男性 52%，30.3 ± 11.1 岁，糖尿病病程 (DD) 18.5 ± 11.6 年，HbA1c 7.8 ± 1.2%），以评估 FLI（基于 BMI、腰围、 γ-谷氨酰转移酶和甘油三酯）以及全因死亡和首次心血管事件。在中位 11 年的随访中，736 名具有可检索发病率数据的个体中有 57 名受试者死亡（7.4%），49 名心血管事件（6.7%）发生。基线时，515 名受试者 (66.5%) 的 FLI < 30，169 名受试者 (21.8%) 的 FLI 为 30-59，90 名受试者 (11.6%) 的 FLI ≥ 60。FLI 导致死亡率急剧增加：3.9%、10.1%、22.2% (p < 0.0001)。在未经调整的 Cox 分析中，与 FLI < 30 相比，FLI 30–59（HR 2.85，95% CI 1.49–5.45，p = 0.002）和 FLI ≥ 60（6.07、3.27–11.29，p < 0.0001）的死亡风险增加。调整 Steno 1 型风险引擎（ST1-RE；基于年龄、性别、DD、收缩压、LDL 胆固醇、HbA1c、白蛋白尿、eGFR、吸烟和锻炼），FLI 30-59 的 HR 为 1.52 (0.78-2.97) FLI ≥ 60 时为 3.04 (1.59–5.82，p = 0.001)。纳入既往 CV 事件稍微修改了 HR。FLI 影响在对 EURODIAB 风险引擎（EURO-RE；基于年龄、HbA1c、腰臀比、蛋白尿和 HDL 胆固醇）进行调整后得到确认：FLI 30–59：HR 1.24、0.62–2.48；FLI ≥ 60：2.54、1.30–4.95，p = 0.007），即使在纳入先前的 CVD 后也是如此。CV 事件发生率随 FLI 增加：3.5%、10.5%、17.2% (p < 0.0001)。在未经调整的 Cox 中，FLI 30–59 的 HR 为 3.24 (1.65–6.34，p = 0.001)，FLI ≥ 60 的 HR 为 5.41 (2.70–10.83，p < 0.0001)。对 ST1-RE 或 EURO-RE 进行调整后，FLI ≥ 60 仍然与心血管事件风险具有统计相关性，只需对之前的 CVD 纳入进行细微修改即可。这项观察性前瞻性研究表明，FLI 与 1 型糖尿病患者全因死亡率较高和心血管事件风险增加相关。