Associations between steatotic liver disease subtypes and incident diabetes in young Korean adults: A nationwide cohort study

초록

Aims The impact of steatotic liver disease (SLD) subtypes on incident type 2 diabetes remains unclear. We investigated the association of metabolic dysfunction-associated steatotic liver disease (MASLD), MetALD (MASLD with moderate alcohol consumption), and alcohol-related liver disease (ALD) with incident type 2 diabetes in Korean adults aged 20-39 years.Materials and Methods Using the Korean National Health Insurance Service database, we included 6 250 145 adults aged 20-39 who underwent health examinations between 2009 and 2012. SLD subtypes were classified by fatty liver index and alcohol intake. Incident type 2 diabetes was assessed using Cox proportional hazards models.Results During a median follow-up of 10.6 years, 72 028 participants developed type 2 diabetes. Incidence rates per 1000 person-years were higher in MASLD (10.56), MetALD (9.96), and ALD (12.49) than in non-SLD (1.29). Multivariable analyses showed significantly increased risks of type 2 diabetes (adjusted hazard ratios [95% CI]: 2.81 [2.78-2.85] for MASLD, 2.92 [2.87-2.98] for MetALD, and 3.99 [3.88-4.09] for ALD).Conclusion All SLD subtypes significantly increased the risk of type 2 diabetes in young adults, with the greatest risk in ALD, followed by MetALD and MASLD. Early detection and management of SLD are essential to reduce the future burden of diabetes.

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