The Search On The Value Of Glvcosvlated Hemoglobin In Nonalcoholic Fatty Liver Disease

Background and Aim:Nonalcoholic fatty liver disease (NAFLD) was an acquired metabolic stress-induced liver disease associated with insulin resistance (IR) and genetic susceptibility, which had a close relationship with central obesity, hypertriglyceridemia, type2diabetes and other metabolic syndrome (MS). Glycosylated hemoglobin (HbAlc) was a sensitive and reliable marker of abnormal glucose metabolism, and could reflect the average blood glucose level of the past1-2months. According to the new standards of medical care in diabetes of the American Diabetes (Year2010), HbAlc had been contained in the diagnostic criteria for diabetes and prediabetes. We sought to analysis the level of HbAlc in NAFLD patients, exploring the value of the level of HbAlc in identify the NAFLD and the significance of screening prediabetes subjects in NAFLD patients.Methods:A cross-sectional study with nondiabetic subjects undergoing medical check-up was conducted in the Medical College of Zhejiang University between January2010and December2010. Obtained the past history and personal history of the healthy subjects of more than18years old and collected the anthropometry indicators, blood biochemistry, fasting insulin, HbAlc and other indicators. Excluded the subjects with previously or new diagnosis diabetes. We collected NAFLD patients according to the result of B ultrasound and the guidelines for the diagnosis and management of NAFLD updated in2010, then analyzed the level of HbAlc in NAFLD patients and NAFLD with disorder glucolipid metabolism or abnormal liver function patients, assessed the value of HbAlc in identify NAFLD using receiver operating characteristics (ROC), and estimated the prevalence of prediabetes subjects in NAFLD patients.Results:(1) There were4710healthy subjects in the final research, and the average age was46.14+6.24years old. There were1866NAFLD patients (39.6%), including85.1%men, and39.3%MS patients. Age>45and<60years old (51.3%) and one level obesity (62.1%) patients were the main part in NAFLD patients.(2) NAFLD patients had higher level of HbAlc when compared with non-NAFLD subjects(5.72±0.32%vs5.57±0.29%, P<0.001), the difference had statistical significance.(3) When compared with NAFLD without IR or MS or abnormal liver function respectively, the level of HbAlc in NAFLD with IR or MS or abnormal liver function was much higher, the difference had statistical significance.(4) All subjects were classified into four categories according to their HbAlc quartile, the prevalence of NAFLD were statistically increased by the increase of HbAlc quartiles (P for trend<0.001).(5) Multiple logistic regression analysis showed HbAlc was an independent risk factor of NAFLD (odd ratio [OR]:1.896,95%confidence interval [CI]:1.461-2.462). After adjustment for age, sex, waist circumference, systolic blood pressure, triglyceride, serum urine acid, low density lipoprotein-cholesterol and homeostatic model assessment of IR, the adjusted OR (95%CI) for the presence of NAFLD in the subjects with the other HbAlc quartiles were0.97(0.78-1.22),1.36(1.08-1.71) and1.66(1.31-2.11)when compared to the subjects with the lowest HbAlc quartile. (6) ROC analysis showed the cut-off value of HbAlc for identify NAFLD was5.65%in men (57.6%sensitivity and61.5%specificity) and5.45%in women (88.5%sensitivity and34.5%specificity).(7) When compared with non-NAFLD subjects or NAFLD without MS patients or NAFLD without abnormal liver function patients respectively, the prevalence of prediabetes in NAFLD patients or NAFLD with MS patients or NAFLD with abnormal liver function patients was much higher, the difference had statistical significance.Conclusions:(1) NAFLD patients with IR or MS or abnormal liver function had much higher level of HbAlc.(2) Elevated HbAlc was an independent risk factor of NAFLD in nondiabetic adult, and the cut-off value of HbAlc for identify NAFLD was5.65%in men and5.45%in women, suggesting that the level of HbAlc may be a peripheral biomaker of NAFLD.(3) The screening of prediabetes in NAFLD patients or NAFLD with disorder metabolism or abnormal liver function patients had more significance.