Cardiac metabolic index as a predictor of new-onset diabetes in non-alcoholic fatty liver disease patients: a longitudinal cohort analysis.

Objective: The purpose of this investigation is to assess the clinical risk linked to the onset of diabetes in individuals with non-alcoholic fatty liver disease (NAFLD) through the utilization of the cardiac metabolic index (CMI), which is derived from triglycerides, high-density lipoprotein, height, and waist circumference. Research focusing on the application of CMI for evaluating diabetes risk among NAFLD patients remains scarce, and an exploration of the association between CMI and the emergence of diabetes within this demographic has not been conducted. This investigation aims to illuminate this connection, thereby providing novel insights into the prevention of diabetes progression in individuals with NAFLD.

Methods: Data were procured from a cross-sectional study involving 15,435 participants conducted by the Japanese government, resulting in a final cohort of 2,503 adults aged 18 and above who met the eligibility criteria for evaluation. The CMI is determined using the formula: TG (mmol/L) / HDL-C (mmol/L) * WHtR. CMI values were categorized into quartiles (Q1 to Q4) based on their scores, arranged from low to high. The investigation utilized logistic regression models, restricted cubic spline analysis, and subgroup analyses, with adjustments made for continuous models to elucidate the association between CMI and diabetes development among individuals with NAFLD, as well as the non-linear relationship between CMI and this outcome.

Results: The investigation comprised 2,503 subjects with an average age of 44.79 ± 8.33 years, of whom 204 were diagnosed with new-onset diabetes (8.15%). Multivariate logistic regression analysis indicated that within the CMI quartile groupings, individuals with NAFLD in the uppermost quartile (Q4) exhibited the greatest likelihood of new-onset diabetes relative to those in the lowest quartile (Q1) (odds ratio, OR = 3.239, 95% confidence interval [CI]: 1.993-5.264, P < 0.001). Additionally, escalating CMI values corresponded to an increasing probability of new-onset diabetes in NAFLD subjects (OR = 1.705, 95% CI: 1.362-2.133, P < 0.001). Restricted cubic spline analysis demonstrated a non-linear connection between CMI and new-onset diabetes in NAFLD patients (P overall < 0.001, P non-linear = 0.035), with a risk inflection point identified at a CMI of 0.5554. Subgroup analysis revealed no significant interactions between gender, age, physical activity, alcohol consumption, or smoking status and the likelihood of new-onset diabetes in this patient population (P for interaction > 0.05).

Conclusion: Findings from this study indicate a notable positive non-linear connection between elevated CMI scores and the probability of new-onset diabetes in individuals afflicted with NAFLD.

Clinical trial number: Not applicable.