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Even a family history of diabetes has been linked to advanced liver fibrosis in non\u2010alcoholic fatty liver disease (NAFLD). However, the fraction of liver\u2010related outcomes in the general population that are attributable to diabetes remains unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The population attributable fraction (PAF) of diabetes for liver disease as a time\u2010dependent exposure was estimated in the Finnish FINRISK study (n\u00a0=\u00a028\u2009787) and the British Whitehall II study (n\u00a0=\u00a07855). We also assessed the predictive ability of a family history of diabetes for liver\u2010related outcomes. Incident diabetes data were from drug purchase\/reimbursement and healthcare registries (FINRISK) or follow\u2010up examinations (Whitehall II). Incident severe liver outcomes were identified through linkage with national healthcare registries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Diabetes was associated with a two\u2010fold risk of liver\u2010related outcomes in both the FINRISK (HR, 1.92; <jats:italic>p<\/jats:italic>\u00a0&lt;\u2009.001) and Whitehall II (HR, 2.37; <jats:italic>p<\/jats:italic>\u00a0&lt;\u2009.001) cohorts, and this remained significant after adjusting for multiple confounders. PAF analyses demonstrated that diabetes explained 12\u201314% of the risk for severe liver\u2010related outcomes after 10 and 20\u2009years of follow\u2010up. Also, maternal diabetes increased the risk of liver\u2010related outcomes in the FINRISK (HR, 1.43; <jats:italic>p<\/jats:italic>\u00a0=\u2009.044) and Whitehall II (HR, 2.04; <jats:italic>p<\/jats:italic>\u00a0=\u2009.051) cohorts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Approximately 12%\u201314% of severe liver\u2010related outcomes are attributable to diabetes at the population level. The association between maternal diabetes and liver disease might suggest a mitochondrial genetic mechanism.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.15296","type":"journal-article","created":{"date-parts":[[2022,5,16]],"date-time":"2022-05-16T09:28:38Z","timestamp":1652693318000},"page":"2186-2194","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Attribution of diabetes to the development of severe liver disease in the general population"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0399-4931","authenticated-orcid":false,"given":"Miika","family":"Vuorinen","sequence":"first","affiliation":[{"name":"Departments of Medicine University of Eastern Finland and Kuopio University Hospital  Kuopio Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0735-400X","authenticated-orcid":false,"given":"Ville T.","family":"M\u00e4nnist\u00f6","sequence":"additional","affiliation":[{"name":"Departments of Medicine University of Eastern Finland and Kuopio University Hospital  Kuopio Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veikko","family":"Salomaa","sequence":"additional","affiliation":[{"name":"Finnish Institute for Health and Welfare  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annie","family":"Britton","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology and Health Care University College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antti","family":"Jula","sequence":"additional","affiliation":[{"name":"Finnish Institute for Health and Welfare  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satu","family":"M\u00e4nnist\u00f6","sequence":"additional","affiliation":[{"name":"Finnish Institute for Health and Welfare  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annamari","family":"Lundqvist","sequence":"additional","affiliation":[{"name":"Finnish Institute for Health and Welfare  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Perola","sequence":"additional","affiliation":[{"name":"Finnish Institute for Health and Welfare  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3833-0705","authenticated-orcid":false,"given":"Fredrik","family":"\u00c5berg","sequence":"additional","affiliation":[{"name":"Transplantation and Liver Surgery Clinic Helsinki University Hospital and University of Helsinki  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,5,27]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(19)30349-8"},{"key":"e_1_2_12_3_1","unstructured":"World Health Organization 2.Global health sector strategy on viral hepatitis 2016\u20132021. 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