OBJECTIVE Type 2 diabetes (T2D) increases the risk for major adverse liver outcomes (MALOs), including cirrhosis and its complications. Patients with T2D frequently have other traits of the metabolic syndrome (MetS). It remains uncertain whether there is a synergistic effect of accumulating MetS traits on future MALO risk. RESEARCH DESIGN AND METHODS Patients with T2D without a history of liver disease were identified from national registers in Sweden from 1998 to 2021. MetS traits included hypertension, low HDL level, hypertriglyceridemia, obesity, and albuminuria, in addition to T2D. MALO events were identified based on administrative coding from national registers until 31 October 2022. Data were analyzed using Cox regression models. RESULTS In total, 230,992 patients were identified (median age 64 years; 58% male), of whom 3,215 (1.39%) developed MALOs over a median follow-up of 9.9 years. Compared with patients with one MetS trait (only T2D) at baseline, those with more than one MetS trait had a higher rate of MALOs (adjusted hazard ratio [aHR] 2.33, 95% CI 1.53–3.54). The rate of MALOs increased progressively with increasing numbers of MetS traits at baseline (aHR 1.28 per added trait, 95% CI 1.23–1.33). During follow-up, patients who acquired additional MetS traits had a progressively higher rate of MALOs. The MetS trait with the largest association with incident MALOs was hypertension (aHR 2.06, 95% CI 1.57–2.71). CONCLUSIONS Having or acquiring additional traits of MetS increase the rate of progression to MALOs in patients with T2D. These results could be used to inform screening initiatives for liver disease.

中文翻译：

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代谢综合征特征会增加 2 型糖尿病患者出现主要不良肝脏结果的风险

目的 2 型糖尿病 (T2D) 会增加主要不良肝脏结局 (MALO) 的风险，包括肝硬化及其并发症。 T2D 患者经常具有代谢综合征 (MetS) 的其他特征。目前尚不确定积累 MetS 特征是否对未来 MALO 风险产生协同效应。研究设计和方法 从 1998 年至 2021 年瑞典国家登记中确定了无肝病史的 T2D 患者。除了 T2D 之外，MetS 特征还包括高血压、低 HDL 水平、高甘油三酯血症、肥胖和蛋白尿。 MALO 事件是根据 2022 年 10 月 31 日之前国家登记册的行政编码确定的。使用 Cox 回归模型对数据进行分析。结果 总共确定了 230,992 名患者（中位年龄 64 岁；58% 为男性），其中 3,215 名患者（1.39%）在中位随访时间 9.9 年中出现 MALO。与基线时具有一种 MetS 特征（仅 T2D）的患者相比，具有一种以上 MetS 特征的患者 MALO 发生率较高（调整后风险比 [aHR] 2.33，95% CI 1.53-3.54）。随着基线时 MetS 性状数量的增加，MALO 的发生率逐渐增加（每个添加性状的 aHR 1.28，95% CI 1.23-1.33）。在随访期间，获得额外 MetS 特征的患者 MALO 发生率逐渐升高。与 MALO 事件关联性最大的 MetS 特征是高血压（aHR 2.06，95% CI 1.57-2.71）。结论 拥有或获得 MetS 的其他特征会增加 T2D 患者进展为 MALO 的速度。这些结果可用于为肝病筛查举措提供信息。