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Visit-to-Visit Fasting Glucose Variability in Young Adulthood and Non-Alcoholic Fatty Liver Disease in Middle Age.

CONTEXT
Diabetes has a bidirectional association with non-alcoholic fatty liver disease (NAFLD), and increases the risk of cirrhosis and related complications.


OBJECTIVE
To investigate the association between visit-to-visit fasting glucose (FG) variability in early adulthood and NAFLD in middle age.


METHODS
This prospective cohort study included 2467 black and white adults aged 18-30 years at baseline (1985-1986) who were followed over 25 years in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. FG variability measures included coefficient of variation about the mean FG (CV-FG), the standard deviation of FG (SD-FG), and the average real variability of FG (ARV-FG) across 25-years (year 0, 7, 10, 15, 20, 25 examinations). NAFLD was defined as liver attenuation ≤ 40 Hounsfield units on CT scan at Year-25 examination after excluding other causes of hepatic steatosis.


RESULTS
Of the 2467 participants, 241 (9.8%) had NAFLD at Year-25. In multivariate analysis, the odds ratio (OR) for NAFLD was 2.80 (95% CI 1.69-4.64, P trend <.001) for the fourth quartile versus first quartile of CV-FG after adjusting for confounding variables, including mean FG. Similar results were observed for SD-FG and ARV-FG.


CONCLUSION
Greater visit-to-visit FG variability in early adulthood was associated with higher risk of NAFLD in middle age independent of mean FG level. FG variability may help identify individuals at high risk for NAFLD.