Association Between the Hepatic Steatosis Index and Risk of Incident Type 2 Diabetes Mellitus in the Normoglycemic Population:A Longitudinal Prospective Study in Japan

Figures & data

Figure 1 Participant flow diagram.

Table 1 Baseline Characteristics of the Participants in Different HSI Groups (n (%) or Mean ± SD or Median [IQR])

Variables	HSI groups				p value
	Q1	Q2	Q3	Q4
n	3611	3610	3611	3611
Male	1506 (41.71%)	1644 (45.54%)	2075 (57.46%)	2713 (75.13%)	<0.001
HSI	26.22 ± 1.47	29.44 ± 0.75	32.29 ± 0.95	38.09 ± 3.56	<0.001
Age(yrs)	42.34±9.19	43.42 ± 8.94	44.51 ± 8.70	43.21 ± 8.07	<0.001
Body Weight (kg)	51.63 ± 7.42	56.82 ± 8.05	61.87 ± 8.54	71.72 ± 10.67	<0.001
BMI (Kg/m^2)	19.12 ± 1.53	20.97 ± 1.58	22.59 ± 1.74	25.45 ± 2.77	<0.001
WC (cm)	68.99 ± 5.86	73.33 ± 6.42	77.65 ± 6.65	85.04 ± 7.85	<0.001
Ethanol consumption (g/wk)	42.00 [77.36]	44.52 [79.88]	52.21 [84.08]	56.31 [89.15]	<0.001
SBP (mmHg)	108.28 ± 13.27	111.64 ± 13.61	115.29 ± 14.22	121.81 ± 14.67	<0.001
DBP (mmHg)	67.55 ± 9.31	69.67 ± 9.69	72.17 ± 10.11	76.34 ± 10.58	<0.001
GGT (IU/L)	15.01 [13.15]	16.28 [11.35]	20.25 [17.83]	28.88 [23.41]	<0.001
ALT (IU/L)	13.31 [5.39]	15.81 [5.80]	19.03 [7.66]	30.64 [21.91]	<0.001
AST (IU/L)	18.11 [6.73]	17.26 [5.42]	17.35 [6.06]	20.08 [13.20]	<0.001
TC (mmol/L)	4.88 ± 0.82	5.02 ± 0.82	5.16 ± 0.85	5.34 ± 0.86	<0.001
TG (mmol/L)	0.64 ± 0.46	0.75 ± 0.48	0.93 ± 0.61	1.27 ± 0.79	<0.001
HDL-c (mmol/L)	1.63 ± 0.39	1.55 ± 0.40	1.43 ± 0.38	1.25 ± 0.33	<0.001
Smoking status					<0.001
Never	2404 (66.57%)	2310 (63.99%)	2049 (56.74%)	1670 (46.25%)
Past	509 (14.10%)	643 (17.81%)	784 (21.71%)	825 (22.85%)
Current	698 (19.33%)	657 (18.20%)	778 (21.55%)	1116 (30.91%)
Habit of exercise					<0.001
No	2984 (82.64%)	2916 (80.78%)	2934 (81.25%)	3071 (85.05%)
Yes	627 (17.36%)	694 (19.22%)	677 (18.75%)	540 (14.95%)
Fatty liver	34 (0.94%)	170 (4.71%)	477 (13.21%)	1691 (46.83%)	<0.001
Incident DM	21 (0.58%)	26 (0.72%)	38 (1.05%)	153 (4.24%)	<0.001

Abbreviations: BMI, body mass index; WC, Waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; GGT, gamma glutamyl transferase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; TC, total cholesterol; TG, total triglycerides; HDL-c, high-density lipoprotein cholesterol.

Figure 2 Kaplan–Meier estimation of incident T2DM by HSI quartiles.

Table 2 Association Between HSI Groups and Incidence of Incident T2DM

HSI groups	Model 1	Model 2	Model 3
	HR (95% CI) P value
Male
Q1	1.0	1.0	1.0
Q2	1.02 (0.55, 1.87)	1.00 (0.54, 1.84)	0.95 (0.51, 1.75)
Q3	1.74 (1.02, 2.99)	1.80 (1.05, 3.08)	1.43 (0.83, 2.46)
Q4	4.54 (2.82, 7.32)	5.08 (3.14, 8.22)	3.21 (1.93, 5.33)
P for trend	1.17 (1.13, 1.21) P<0.001	1.18 (1.14, 1.23) P<0.001	1.13 (1.09, 1.18) P<0.001
per SD increase	1.93 (1.71, 2.17)	2.11 (1.86, 2.39)	1.82 (1.58, 2.10)
Female
Q1	1.0	1.0	1.0
Q2	1.51 (0.36, 6.33)	1.44 (0.34, 6.04)	1.29 (0.31, 5.44)
Q3	3.24 (0.90, 11.62)	2.99 (0.83, 10.76)	2.38 (0.66, 8.64)
Q4	8.89 (2.71, 29.20)	7.70 (2.33, 25.49)	4.64 (1.36, 15.81)
P for trend	1.32 (1.19, 1.47) P<0.001	1.30 (1.17, 1.45) P<0.001	1.21 (1.09, 1.36) P<0.001
per SD increase	2.19 (1.81, 2.66)	2.18 (1.79, 2.67)	1.80 (1.43, 2.27)
Total
Q1	1.0	1.0	1.0
Q2	1.17 (0.66, 2.07)	1.13 (0.64, 2.01)	1.09 (0.61, 1.93)
Q3	1.58 (0.93, 2.69)	1.46 (0.86, 2.49)	1.16 (0.68, 1.98)
Q4	6.10 (3.87, 9.64)	5.98 (3.79, 9.44)	3.30 (2.04, 5.33)
P for trend	1.23 (1.18, 1.27) P<0.001	1.23 (1.19, 1.28) P<0.001	1.15 (1.11, 1.20) P<0.001
per SD increase	2.06 (1.87, 2.26)	2.19 (1.98, 2.42)	1.81 (1.61, 2.03)

Notes: Model 1 was not adjusted, Model 2 was adjusted for age, Model 3 was adjusted for age, Ethanol consumption, Smoking status, SBP, DBP, TG, TC.

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; TG, total triglycerides; TC, total cholesterol.

Figure 3 Receiver operative characteristic curve of HSI for identifying incident T2DM.

Table 3 Subgroup Analysis of the Impact of HSI on T2DM Incidence

Variables	HSI continue variable
	HR, 95% CI	P value	P for interaction
Sex			0.0916
Female	1.18 (1.12, 1.24)	<0.0001
Male	1.12 (1.09, 1.15)	<0.0001
Age			0.3195
<60	1.11 (1.09, 1.14)	<0.0001
≥60	1.20 (1.04, 1.40)	0.0156
BMI			0.6508
<24	1.12 (1.07, 1.18)	<0.0001
≥24	1.14 (1.10, 1.18)	<0.0001
SBP			0.1930
<140	1.14 (1.11, 1.17)	<0.01
≥140	1.10 (1.04, 1.16)	0.0012
TG			0.0170
<1.7	1.15 (1.12, 1.19)	<0.0001
≥1.7	1.09 (1.05, 1.14)	<0.0001

Notes: The model adjusted for the following variables: age, ethanol consumption, smoking status, SBP, DBP, TG and TC excluding itself.

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; TG, total triglycerides; TC, total cholesterol.