Occurrence over time and regression of nonalcholic fatty liver disease in type 2 diabetes

Background This analysis was aimed to assess the incidence, regression, and correlated factors of nonalcoholic fatty liver disease (NAFLD) in type 2 diabetes, which are poorly known. Methods Nonalcoholic fatty liver disease (defined as fatty liver index [FLI] score ≥ 60) in patients with type 2 diabetes, and related factors was investigated in a nationwide database containing information from the Italian network of diabetes clinics. A 10% variation of FLI was the cut‐off considered in the analyses of a cohort of 5030 patients, which was separately conducted for those who developed, maintained, or recovered from FLI‐assessed NAFLD (FLI‐NAFLD) over a 3‐year period. Results At baseline, FLI‐NAFLD was diagnosed in 61.3% of patients. Within the 3‐year study period, FLI‐NAFLD occurred in 313 patients and remitted in 410. The FLI score remained unchanged in 4307. Body‐mass index (odds ratio, 1.45 95%; confidence interval, 1.35‐1.55), abdominal obesity (2.11; 1.64‐2.72), low HDL cholesterol levels (1.38; 1.02‐1.87), and triglycerides (1.20; 1.12‐1.28) all emerged as notable negative prognostic factors for the development or maintenance of FLI‐NAFLD. The regression rate of FLI‐NAFLD was higher among patients who managed to partially control these factors. Male sex and established organ damage, especially kidney function (1.64; 1.12‐2.42), were independent risk predictors. Unlike other diabetes complications, FLI‐NAFLD was more frequent among younger patients or those with a shorter duration of diabetes. Conclusions FLI‐assessed NAFLD is a dynamic condition, with about 5% of diabetic patients entering or leaving the status every year. Younger male patients with insulin resistance or organ damage have a higher risk of presenting with FLI‐NAFLD at baseline, developing FLI‐NAFLD within 3 years, and a lower probability of regression.