Gestational diabetes history ups NAFLD risk in women

Women with a history of gestational diabetes mellitus (GDM) are at higher risk of developing nonalcoholic fatty liver disease (NAFLD), suggests a recent study.

Of note, <10 percent of the association between GDM and incident NAFLD is independently explained by insulin resistance, as measured by the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), and development of diabetes.

A total of 64,397 Korean parous women without NAFLD were included in this retrospective cohort study. Liver ultrasonography was used to assess the presence and severity of NAFLD at baseline and follow-up.

The authors calculated the adjusted hazard ratios (aHRs) for incident NAFLD according to a self-reported GDM history using Cox proportional hazard models, with adjustments for confounders as time-dependent variables. They also carried out mediation analyses to determine whether diabetes or insulin resistance mediated the relationship between previous GDM and incident NAFLD.

Of the women, 6,032 developed incident NAFLD (343 had moderate-to-severe NAFLD) during a median follow-up of 3.7 years.

In multivariate analysis, women with time-dependent history of GDM had a higher risk of incident overall NAFLD (aHR, 1.46, 95 percent confidence interval [CI], 1.33‒1.59) and moderate-to-severe NAFLD (aHR, 1.75, 95 percent CI, 1.25‒2.44) than those without previous GDM.

Such associations persisted in analyses of women with normal fasting glucose <100 mg/dL or in those that excluded women with prevalent diabetes at baseline or incident diabetes during follow-up.

“Diabetes and insulin resistance (HOMA-IR) each mediated <10 percent of the association between previous GDM and overall NAFLD development,” the authors said.