Fatty liver index-defined hepatic steatosis and impaired fasting glucose differentially associate with incident diabetes and cardiovascular events in older adults: a nationwide cohort study
8 affiliations
- 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chosun University Hospital, Gwangju, Republic of Korea
- 2Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Republic of Korea
- 3Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea
- 4Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- 5Yonsei Institute for Digital Health, Yonsei University, Seoul, Republic of Korea
- 6Division of Nephrology, Department of Internal Medicine, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Republic of Korea
- 7Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea
- 8Department of Biological Chemistry, University of California Irvine, Sprague Hall, 839 Health Sciences Road, Irvine, CA USA
Abstract
Background: Hepatic steatosis and prediabetes are increasingly prevalent among older adults; however, their respective impacts on cardiometabolic outcomes remain unclear. We aimed to evaluate the associations of hepatic steatosis and prediabetes with incident diabetes and cardiovascular outcomes in this population.
Methods: This nationwide cohort study included 142,518 adults aged ≥ 65 years without diabetes. Hepatic steatosis was defined using the fatty liver index (FLI ≥ 60), and impaired fasting glucose (IFG) was defined by fasting glucose levels of 100–125 mg/dL. Outcomes included incident diabetes and composite major adverse cardiovascular events (MACE), comprising myocardial infarction, stroke, heart failure, or cardiovascular death, which were analyzed using multivariable Cox proportional hazards models and Fine–Gray subdistribution hazard models.
Results: At baseline, FLI-defined hepatic steatosis was identified in 6.6% of participants, while 30.6% had IFG. After multivariable adjustment, FLI-defined hepatic steatosis was associated with incident diabetes (SHR 1.67; 95% CI 1.59–1.76; P < 0.001) and composite MACE (SHR 1.21; 95% CI 1.15–1.29; P < 0.001). IFG was associated with an increased risk of incident diabetes (SHR 2.54; 95% CI 2.47–2.62; P < 0.001) but was not independently associated with composite MACE. In joint analyses, FLI-defined hepatic steatosis was consistently associated with an elevated risk of composite MACE regardless of glycemic status, with SHRs of 1.23 (95% CI 1.14–1.32; P < 0.001) among normoglycemic individuals and 1.20 (95% CI 1.11–1.31; P < 0.001) among those with IFG. In contrast, IFG without FLI-defined hepatic steatosis was not associated with an increased risk of composite MACE compared with normoglycemic individuals without FLI-defined hepatic steatosis.
Conclusion: In older adults, FLI-defined hepatic steatosis is a strong predictor of both incident diabetes and cardiovascular events, whereas IFG shows no independent association with cardiovascular outcomes.
Trial registration: Not applicable (retrospectively registered).
Graphical Abstract:
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12933-026-03341-7.
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BibTeX
@article{lyu2026fatty,
title = {{Fatty liver index-defined hepatic steatosis and impaired fasting glucose differentially associate with incident diabetes and cardiovascular events in older adults: a nationwide cohort study}},
author = {Young Sang Lyu and Minae Park and Hee Kyung Kim and Sojeong Park and Kyoung Hwa Ha and Youngmin Yoon and Jin Hwa Kim and Sang Yong Kim and Dae Jung Kim and Ho-Cheol Kang and Wonsuk Choi},
journal = {Cardiovascular Diabetology},
year = {2026},
month = aug,
doi = {10.1186/s12933-026-03341-7},
url = {https://doi.org/10.1186/s12933-026-03341-7},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Fatty liver index-defined hepatic steatosis and impaired fasting glucose differentially associate with incident diabetes and cardiovascular events in older adults: a nationwide cohort study
AU - Young Sang Lyu
AU - Minae Park
AU - Hee Kyung Kim
AU - Sojeong Park
AU - Kyoung Hwa Ha
AU - Youngmin Yoon
AU - Jin Hwa Kim
AU - Sang Yong Kim
AU - Dae Jung Kim
AU - Ho-Cheol Kang
AU - Wonsuk Choi
PY - 2026
DA - 2026/08/19
JO - Cardiovascular Diabetology
DO - 10.1186/s12933-026-03341-7
UR - https://doi.org/10.1186/s12933-026-03341-7
AB - Background: Hepatic steatosis and prediabetes are increasingly prevalent among older adults; however, their respective impacts on cardiometabolic outcomes remain unclear. We aimed to evaluate the associations of hepatic steatosis and prediabetes with incident diabetes and cardiovascular outcomes in this population. Methods: This nationwide cohort study included 142,518 adults aged ≥ 65 years without diabetes. Hepatic steatosis was defined using the fatty liver index (FLI ≥ 60), and impaired fasting glucose (IFG) was defined by fasting glucose levels of 100–125 mg/dL. Outcomes included incident diabetes and composite major adverse cardiovascular events (MACE), comprising myocardial infarction, stroke, heart failure, or cardiovascular death, which were analyzed using multivariable Cox proportional hazards models and Fine–Gray subdistribution hazard models. Results: At baseline, FLI-defined hepatic steatosis was identified in 6.6% of participants, while 30.6% had IFG. After multivariable adjustment, FLI-defined hepatic steatosis was associated with incident diabetes (SHR 1.67; 95% CI 1.59–1.76; P < 0.001) and composite MACE (SHR 1.21; 95% CI 1.15–1.29; P < 0.001). IFG was associated with an increased risk of incident diabetes (SHR 2.54; 95% CI 2.47–2.62; P < 0.001) but was not independently associated with composite MACE. In joint analyses, FLI-defined hepatic steatosis was consistently associated with an elevated risk of composite MACE regardless of glycemic status, with SHRs of 1.23 (95% CI 1.14–1.32; P < 0.001) among normoglycemic individuals and 1.20 (95% CI 1.11–1.31; P < 0.001) among those with IFG. In contrast, IFG without FLI-defined hepatic steatosis was not associated with an increased risk of composite MACE compared with normoglycemic individuals without FLI-defined hepatic steatosis. Conclusion: In older adults, FLI-defined hepatic steatosis is a strong predictor of both incident diabetes and cardiovascular events, whereas IFG shows no independent association with cardiovascular outcomes. Trial registration: Not applicable (retrospectively registered). Graphical Abstract: Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12933-026-03341-7.
SN - 1475-2840
ER -