TY - JOUR
T1 - Gestational diabetes mellitus is strongly associated with non-alcoholic fatty liver disease
AU - Ajmera, Veeral H.
AU - Gunderson, Erica P.
AU - Vanwagner, Lisa B.
AU - Lewis, Cora E.
AU - Carr, John J.
AU - Terrault, Norah A.
N1 - Funding Information:
No direct fi nancial sponsors for this project. CARDIA is supported by the NHLBI. Analyses were supported by K01 and R01 grants to Dr Gunderson, T32 salary support for Dr Ajmera, R01 support for Dr Carr and AASLD grant for Dr VanWagner. Th e Coronary Artery Risk Development in Young Adults Study (CARDIA) is conducted and supported by the National Heart, Lung, and Blood Institute in collaboration with the University of Alabama at Birmingham (HHSN268201300025C and HHSN268201300026C), Northwestern University (HHSN268201300027C), University of Minnesota (HHSN268201300028C), Kaiser Foundation Research Institute (HHSN268201300029C), and Johns Hopkins University School of Medicine (HHSN268200900041C). CARDIA is also partially supported by the Intramural Research Program of the National Institute on Aging. Th e analyses were supported by grants from K01 DK059944 (Dr Gunderson, PI), R01 DK090047 (Dr Gunderson, PI) and T32 5T32DK060414-13 (Dr Maher, PI) from the National Institute of Diabetes, Digestive and Kidney Diseases and R01 HL098445 (Dr Carr) from the National Heart, Lung, and Blood Institute. Dr VanWagner is supported by the American Association for the Study of Liver Diseases Foundation and the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number KL2TR001. Dr Veeral Ajmera is supported in part by an NIH funded postdoctoral research training program grant (T32 DK060414).
Publisher Copyright:
© 2016 by the American College of Gastroenterology.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Objectives:Insulin resistance is central to the development of non-alcoholic fatty liver disease (NAFLD), and gestational diabetes mellitus (GDM) is an early marker of insulin resistance. We hypothesized that a history of GDM would identify women at higher risk of NAFLD in middle age.Methods:Women from the multicenter Coronary Artery Risk Development in Young Adults (CARDIA) cohort study who delivered ≥1 birth, were free of diabetes prior to pregnancy(ies), and underwent CT quantification of hepatic steatosis 25 years following cohort entry (Y25: 2010-2011) were included (n=1,115). History of GDM by self-report, validated in a subsample by review of antenatal glucose testing, and metabolic risk factors were assessed prospectively. NAFLD was defined by liver attenuation (LA)≤40 Hounsfield Units on CT scan after exclusion of other causes of hepatic steatosis.Results:Of 1,115 women meeting selection criteria (57% black, 43% white, median age 25 years at baseline), 124 (11%) reported a history of GDM and 75 (7%) met the CT definition for NAFLD at year 25. The crude risk of NAFLD at the 25-year visit was significantly higher in women with GDM compared to those without (14 vs. 5.8%, OR: 2.56, 95% CI: 1.44-4.55, P<0.01). History of GDM remained associated with NAFLD (OR: 2.29, 95% CI: 1.23-4.27, P=0.01) after adjustment for covariates in multivariable logistic regression. Addition of incident diabetes mellitus (DM) into the final model attenuated the association between GDM and NAFLD (OR: 1.48, 95% CI: 0.73-3.02, P=0.28). Conclusion: GDM is a risk marker for NAFLD and represents an opportunity to identify women at risk for NAFLD at a young age and may be mediated by the development of incident DM.
AB - Objectives:Insulin resistance is central to the development of non-alcoholic fatty liver disease (NAFLD), and gestational diabetes mellitus (GDM) is an early marker of insulin resistance. We hypothesized that a history of GDM would identify women at higher risk of NAFLD in middle age.Methods:Women from the multicenter Coronary Artery Risk Development in Young Adults (CARDIA) cohort study who delivered ≥1 birth, were free of diabetes prior to pregnancy(ies), and underwent CT quantification of hepatic steatosis 25 years following cohort entry (Y25: 2010-2011) were included (n=1,115). History of GDM by self-report, validated in a subsample by review of antenatal glucose testing, and metabolic risk factors were assessed prospectively. NAFLD was defined by liver attenuation (LA)≤40 Hounsfield Units on CT scan after exclusion of other causes of hepatic steatosis.Results:Of 1,115 women meeting selection criteria (57% black, 43% white, median age 25 years at baseline), 124 (11%) reported a history of GDM and 75 (7%) met the CT definition for NAFLD at year 25. The crude risk of NAFLD at the 25-year visit was significantly higher in women with GDM compared to those without (14 vs. 5.8%, OR: 2.56, 95% CI: 1.44-4.55, P<0.01). History of GDM remained associated with NAFLD (OR: 2.29, 95% CI: 1.23-4.27, P=0.01) after adjustment for covariates in multivariable logistic regression. Addition of incident diabetes mellitus (DM) into the final model attenuated the association between GDM and NAFLD (OR: 1.48, 95% CI: 0.73-3.02, P=0.28). Conclusion: GDM is a risk marker for NAFLD and represents an opportunity to identify women at risk for NAFLD at a young age and may be mediated by the development of incident DM.
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U2 - 10.1038/ajg.2016.57
DO - 10.1038/ajg.2016.57
M3 - Article
C2 - 27002796
AN - SCOPUS:84966687571
SN - 0002-9270
VL - 111
SP - 658
EP - 664
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 5
ER -