Increased risks of different grades of non‐alcoholic fatty liver disease in prediabetic subjects with impaired fasting glucose and glucose tolerance, including the isolated glycosylated hemoglobin levels of 5.7–6.4% in a Chinese population

AIMS/INTRODUCTION: Contrary to the results of the majority of studies on diabetes, there are some conflicting results regarding the relationship between non‐alcoholic fatty liver disease (NAFLD) and prediabetes. No study has investigated the relationship between isolated glycated hemoglobin (HbA1c) in the range of 5.7–6.4% (HbA1c 5.7–6.4%) and NAFLD. Our aim was to investigate the effect of different glycemic statuses on NAFLD concomitantly categorized by fasting plasma glucose, 2‐h plasma glucose and HbA1c levels. MATERIALS AND METHODS: NAFLD was classified into three groups by ultrasonographic examination results: normal, mild and moderate‐to‐severe. Glycemic status was divided into five groups: normoglycemia, isolated HbA1c 5.7–6.4%, impaired fasting glucose without impaired glucose tolerance (IGT), IGT and newly diagnosed diabetes. For multivariable logistic regression analyses, the outcome variable was the classified three grades of fatty changes in the liver after adjusting for other potential risk covariables. RESULTS: In this cross‐sectional research, a total of 8,571 eligible individuals were enrolled and divided into three groups: 5,499 without fatty liver, 2,113 with mild NAFLD and 959 with moderate‐to‐severe NAFLD. Multivariable logistic regression analysis showed that IGT, impaired fasting glucose without IGT and isolated HbA1c 5.7–6.4% were associated with a higher risk of NAFLD in addition to newly diagnosed diabetes. Other positively predictive variables were male sex, obesity, overweight, central obesity, increased triglyceride and C‐reactive protein >1 mg/L. Negatively associated factors were elevated high‐density lipoprotein cholesterol levels. CONCLUSIONS: Besides diabetes, the increased risks of different grades of NAFLD were found for prediabetic individuals categorized by impaired fasting glucose without IGT, IGT and isolated HbA1c 5.7–6.4%.