BACKGROUND & AIMS Fatty liver is associated with incident diabetes, and the fatty liver index (FLI) is a surrogate marker for non-alcoholic fatty liver disease (NAFLD). We aimed to determine whether or not FLI was associated with incident diabetes in relation to obesity and prediabetic levels in the general Japanese population. METHODS This was a retrospective study using the Japanese health check-up database of one health insurance from FY2015 to FY2018. This study included 28,991 individuals with prediabetes. First, we stratified all participants into two groups: "high-risk," comprising patients with HbA1c >6.0%, and "standard," comprising the rest. Subsequently, we divided them into four groups according to FLI (<30 or not) and obesity (BMI <25 kg/m2 or not). Subsequently, the incidence rate of diabetes was compared among the groups after 3 years of follow-up using multiple logistic regression models after adjusting for potential confounders. RESULTS After 3 years of follow-up, 1,547 new cases of diabetes were found, and the cumulative incidence was 2.96% for the standard group and 26.1% for the high-risk group. In non-obese individuals, odds ratios (95% confidence interval) for FLI ≥30 versus FLI <30 were: 1.44 (1.09-1.92) for the standard group and 1.42 (0.99-2.03) for the high-risk group. In the high-risk group, obesity (BMI ≥25 kg/m2) but FLI <30 was not a risk factor for developing diabetes. CONCLUSION Although high FLI is generally considered to be a risk factor for developing diabetes, obesity might have been a confounding factor. However, the present study showed that high FLI is a risk factor for the development of diabetes, even in non-obese individuals. Our results include suggestion to develop a screening tool to effectively identify people at high risk of developing diabetes from the population (especially non-obese prediabetes) who are apparently at low health risk and are unlikely to be targeted for health guidance.

中文翻译：

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脂肪肝指数作为糖尿病发展的预测标志物：一项使用日本健康检查数据的回顾性队列研究。

背景和目的 脂肪肝与糖尿病发病率有关，脂肪肝指数 (FLI) 是非酒精性脂肪肝 (NAFLD) 的替代指标。我们旨在确定 FLI 是否与普通日本人群的肥胖和糖尿病前期水平相关的糖尿病事件相关。方法 这是一项回顾性研究，使用了 2015 财年至 2018 财年的一项健康保险的日本健康检查数据库。该研究包括 28,991 名糖尿病前期患者。首先，我们将所有参与者分为两组：“高风险”，包括 HbA1c > 6.0% 的患者，以及“标准”，包括其余的患者。随后，我们根据 FLI（<30 与否）和肥胖（BMI <25 kg/m2 与否）将他们分为四组。随后，在对潜在混杂因素进行调整后，使用多元逻辑回归模型比较随访 3 年后各组之间的糖尿病发病率。结果 随访3年，共发现糖尿病新发病例1547例，标准组累计发生率为2.96%，高危组累计发生率为26.1%。在非肥胖个体中，FLI ≥30 与 FLI <30 的比值比（95% 置信区间）为：标准组为 1.44 (1.09-1.92)，高风险组为 1.42 (0.99-2.03)。在高危组中，肥胖（BMI ≥ 25 kg/m2）但 FLI <30 不是发生糖尿病的危险因素。结论 尽管高 FLI 通常被认为是发生糖尿病的危险因素，但肥胖可能是一个混杂因素。然而，本研究表明，高 FLI 是糖尿病发展的危险因素，即使在非肥胖个体中也是如此。我们的研究结果包括建议开发一种筛查工具，以有效地从人群（尤其是非肥胖的糖尿病前期）中有效识别出明显处于低健康风险且不太可能成为健康指导目标的人群中发展为糖尿病的高危人群。