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Cited by 61Liver Disease Diagnosis and TreatmentDiabetes, Cardiovascular Risks, and LipoproteinsChronic Kidney Disease and Diabetes

Metabolic syndrome traits increase the risk of major adverse liver outcomes in type 2 diabetes

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Shang, Ying, Grip, Emilie Toresson, Modica, Angelo, Skröder, Helena, Ström, Oskar, Ntanios, Fady, Gudbjörnsdottir, Soffia, Hagström, Hannes·2024·Diabetes Care
DOI 10.2337/dc23-1937PMC PMC11116921
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Abstract

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.

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  • Having several cardiometabolic risk factors confers a greater risk of progressive liver damage and major adverse liver outcomes.

    “Conversely, having several cardiometabolic risk factors confers a greater risk of progressive liver damage and major adverse liver outcomes. 17,35”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [17]

    The Conclusions report that, among patients with type 2 diabetes, each additional metabolic syndrome trait was associated with a stepwise increase in major adverse liver outcomes. The claim omits that population restriction and refers to progressive liver damage more broadly than the outcomes reported; “confers” also implies a stronger causal conclusion than the study’s association. (LLM, conf=0.84)

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  • In a Swedish cohort study, the cumulative incidence of major adverse liver outcomes over ten years in individuals with T2D increased with the number of components of the metabolic syndrome, but was still <2% in those presenting with all 5 components.

    “Still, in a Swedish cohort study, the cumulative incidence of major adverse liver outcomes over ten years in individuals with T2D increased with the number of components of the metabolic syndrome, but was still &lt; 2% in those presenting with all 5 components. 17”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [17]

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Authors
Shang, Y., Grip, E. T., Modica, A., Skröder, H., Ström, O., Ntanios, F., Gudbjörnsdottir, S., & Hagström, H.
Affiliations
  • Karolinska Institutet (SE)
  • 3Pfizer AB, Stockholm, Sweden
  • Quantify Research (Sweden) (SE)
  • Pfizer (United States) (US)
  • 5Swedish National Diabetes Register
  • Karolinska University Hospital (SE)
Corresponding author
Shang, Ying
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2024-03-18
Volume
47
Issue
6
Pages
978-985
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc23-1937
PMC
PMC11116921
OpenAlex
W4392907512
Cited by
61
References
37
Citations by year
2026: 16 · 2025: 30 · 2024: 15
FWCI
18.61
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/journals/pages/license (vor)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • The Swedish Research Council
  • Mag-TarmFonden, Swedish Gastroenterology Society
  • Pfizer
  • Karolinska Institutet
Topics
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Keywords
type 2 diabetes, metabolic syndrome, major adverse liver outcomes, liver cirrhosis, hypertension, hypertriglyceridemia, low HDL cholesterol, obesity, albuminuria, liver disease screening, disease progression
MeSH terms
Aged, Diabetes Mellitus, Type 2, Female, Humans, Liver Diseases, Male, Middle Aged, Risk Factors, Sweden, Metabolic Syndrome

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