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We aim to investigate whether C\u2010peptide is associated with nonalcoholic fatty liver disease (NAFLD) progression in type 2 diabetic adults.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 4937 diabetic participants were enrolled from China in 2018. Liver steatosis was detected by ultrasound. Subjects with NAFLD were categorized into simple NAFLD and probable NASH by the concurrent presence of metabolic syndrome. NAFLD fibrosis score was used to identify patients with probable advanced fibrosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Individuals with a longer history of type 2 diabetes had a lower C\u2010peptide level and a lower prevalence of probable NASH but a higher prevalence of advanced fibrosis. C\u2010peptide was positively associated with simple NAFLD and probable NASH, with odds ratios (ORs) of 4.55 [95% confidence interval (CI) 3.16, 6.55] and 5.28 (95% CI 3.94, 7.09), respectively, comparing quartile 4 with quartile 1 (both <jats:italic>p<\/jats:italic> for trend &lt;0.001). However, C\u2010peptide quartiles were negatively associated with the probable presence of advanced fibrosis (Q4 vs. Q1, OR 0.59, 95% CI 0.36, 0.97, <jats:italic>p<\/jats:italic> for trend &lt;0.05). A 1\u2010SD increment of ln(C\u2010peptide) was also significantly associated with inflammatory and fibrotic progression (OR 1.34, 95% CI 1.27, 1.41; OR 0.88, 95% CI 0.79, 0.98, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Significant but opposite associations between C\u2010peptide and inflammatory and fibrotic progression of NAFLD were observed. Understanding islet hormone changes during type 2 diabetes and differentiating the stage of NAFLD may help to personalize treatment strategies for NAFLD patients with type 2 diabetes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/dmrr.3210","type":"journal-article","created":{"date-parts":[[2019,7,27]],"date-time":"2019-07-27T17:32:49Z","timestamp":1564248769000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["C\u2010peptide is associated with NAFLD inflammatory and fibrotic progression in type 2 diabetes"],"prefix":"10.1002","volume":"36","author":[{"given":"Ningjian","family":"Wang","sequence":"first","affiliation":[{"name":"Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine  Shanghai 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