{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T11:52:07Z","timestamp":1785585127307,"version":"3.56.0"},"reference-count":33,"publisher":"FapUNIFESP (SciELO)","issue":"3","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cad. Sa\u00fade P\u00fablica"],"abstract":"<jats:p>Increasing epidemiological evidence suggests a bidirectional relationship between non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes, and that NAFLD may precede and\/or promote the development of diabetes. This study aimed to investigate whether liver steatosis is associated with the incidence of diabetes in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The ELSA-Brasil is an occupational cohort study of active or retired civil servants, aged 35-74 years, in six capital cities in Brazil. We excluded participants with diabetes at baseline, those who reported excessive alcohol consumption or with missing information on relevant covariates, and those with self-referred hepatitis or cirrhosis. In total, 8,166 individuals participated, and the mean duration of follow-up was 3.8 years. The Cox proportional regression model was used to estimate the adjusted hazard ratio (HR) for the associations. Abdominal ultrasonography was used to detect liver steatosis. In the follow-up period, the cumulative incidence of diabetes was 5.25% in the whole sample, 7.83% and 3.88% in the groups with and without hepatic steatosis, respectively (p &lt; 0.001). Compared to those without steatosis, individuals with hepatic steatosis had an increased risk of developing diabetes (HR = 1.31; 95%CI: 1.09-1.56) after adjustment for potential confounders, including body mass index (BMI). Hepatic steatosis was an independent predictor of incident diabetes in the ELSA-Brasil cohort study. Physicians should encourage changes in lifestyle and screen for diabetes in patients with fatty liver.<\/jats:p>","DOI":"10.1590\/0102-311xen090522","type":"journal-article","created":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T09:45:52Z","timestamp":1680515152000},"source":"Crossref","is-referenced-by-count":4,"title":["Liver steatosis as a predictor of incident diabetes in adults: a prospective evaluation in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)"],"prefix":"10.1590","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0226-3491","authenticated-orcid":false,"given":"Luciana Costa","family":"Faria","sequence":"first","affiliation":[{"name":"Universidade Federal de Minas Gerais,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9146-5003","authenticated-orcid":false,"given":"Maria de F\u00e1tima Haueisen Sander","family":"Diniz","sequence":"additional","affiliation":[{"name":"Universidade Federal de Minas Gerais,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luana","family":"Giatti","sequence":"additional","affiliation":[{"name":"Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3837-0731","authenticated-orcid":false,"given":"Maria In\u00eas","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Universidade Federal do Rio Grande do Sul,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1076-5210","authenticated-orcid":false,"given":"Alessandra Carvalho","family":"Goulart","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7491-2630","authenticated-orcid":false,"given":"Bruce Bartholow","family":"Duncan","sequence":"additional","affiliation":[{"name":"Universidade Federal do Rio Grande do Sul,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7383-7811","authenticated-orcid":false,"given":"Sandhi Maria","family":"Barreto","sequence":"additional","affiliation":[{"name":"Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2023]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1111\/j.1365-2036.2011.04724.x","article-title":"Systematic review the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults","volume":"34","author":"Vernon G","year":"2011","journal-title":"Aliment Pharmacol Ther"},{"issue":"6","key":"ref2","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1016\/S1262-3636(08)74597-X","article-title":"Definition and natural history of metabolic steatosis clinical aspects of NAFLD, NASH and cirrhosis","volume":"34","author":"Serfaty L","year":"2008","journal-title":"Diabetes Metab"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1016\/S0140-6736(16)00618-8","article-title":"Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4\u00b74 million participants.","volume":"387","year":"2016","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1056\/NEJMoa1008862","article-title":"Diabetes mellitus, fasting glucose, and risk of cause-specific death","volume":"364","author":"Seshasai SRK","year":"2011","journal-title":"N Engl J Med"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1056\/NEJMoa012512","article-title":"Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin","volume":"346","author":"Knowler WC","year":"2002","journal-title":"N Engl J Med"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1016\/S0140-6736(11)60135-9","article-title":"Chronic non-communicable diseases in Brazil burden and current challenges","volume":"377","author":"Schmidt MI","year":"2011","journal-title":"Lancet"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"2042","DOI":"10.1016\/S0140-6736(11)60055-X","article-title":"Health conditions and health-policy innovations in Brazil the way forward","volume":"377","author":"Victora CG","year":"2011","journal-title":"Lancet"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1038\/nrgastro.2013.41","article-title":"Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis","volume":"10","author":"Anstee QM","year":"2013","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"419","DOI":"10.2337\/dc16-1787","article-title":"Management of nonalcoholic fatty liver disease in patients with type 2 diabetes a call to action","volume":"40","author":"Bril F","year":"2017","journal-title":"Diabetes Care"},{"issue":"1 Suppl","key":"ref10","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1016\/j.jhep.2014.12.012","article-title":"NAFLD a multisystem disease","volume":"62","author":"Byrne CD","year":"2015","journal-title":"J Hepatol"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.diabet.2016.04.002","article-title":"Risk of type 2 diabetes in patients with non-alcoholic fatty liver disease causal association or epiphenomenon?","volume":"42","author":"Targher G","year":"2016","journal-title":"Diabetes 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mellitus and its complications."},{"key":"ref26","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1249\/01.MSS.0000117161.66394.07","article-title":"Reliability and validity of the International Physical Activity Questionnaire (IPAQ)","volume":"36","author":"Hallal PC","year":"2004","journal-title":"Med Sci Sports Exerc"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1590\/1516-3180.2014.9150812","article-title":"Diagnostic accuracy of a noninvasive hepatic ultrasound score for non-alcoholic fatty liver disease (NAFLD) in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)","volume":"133","author":"Goulart AC","year":"2015","journal-title":"Sao Paulo Med J"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/S2213-8587(19)30058-0","article-title":"Intermediate hyperglycaemia to predict progression to type 2 diabetes (ELSA-Brasil) an occupational cohort study in Brazil","volume":"7","author":"Schmidt 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(ELSA-Brasil)"],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S0102-311X2023000305005&tlng=en","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T09:46:12Z","timestamp":1680515172000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0102-311X2023000305005&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023]]},"references-count":33,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023]]}},"alternative-id":["S0102-311X2023000305005"],"URL":"https:\/\/doi.org\/10.1590\/0102-311xen090522","relation":{},"ISSN":["1678-4464","0102-311X"],"issn-type":[{"value":"1678-4464","type":"electronic"},{"value":"0102-311X","type":"print"}],"subject":[],"published":{"date-parts":[[2023]]},"article-number":"e00090522"}}