The Ratio of Liver to Spleen (L/S Ratio) for CT Attenuation Value Is Associated with the Onset of Diabetes Mellitus in a Community-Based Sample of Japanese Men—The Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA)

Background and Aim: Fatty liver is reported to be associated with type 2 diabetes mellitus. Most of the previous studies are cross-sectional and liver fat was evaluated using ultrasound echography or plasma levels of liver enzyme. We assessed liver fat content in a semi-quantitative method using computed tomographic (CT) images and verified the hypothesis that the L/S ratio for CT attenuation value was associated with the onset of diabetes in longitudinal observational cohort study of Japanese men.

Methods: Participants were randomly selected men from Kusatsu City, Japan. We analyzed 622 participants (63.5±9.9 years) without diabetes at baseline. We calculated odds ratio (OR) and 95% confidence interval (CI) of the presence of fatty liver (defined by L/S ratio<1.0) and per 1 standard deviation (SD) decrease in L/S ratio for the development of diabetes, using logistic regression model. Adjustments were age, family history of diabetes, smoking pack year, alcohol consumption, step count and BMI. We added stratified analysis at BMI 25 kg/m². Diabetes was diagnosed as follows; HbA1c ≥6.5% or fasting plasma glucose ≥126 mg/dL or taking diabetes medication.

Results: During 5.1±1.4 years of follow-up period, 36 participants (5.8%) developed diabetes. Although the presence of fatty liver was not significantly associated with the development of diabetes (OR 1.77, 95% CI 0.81-3.85), OR for those of per 1 SD (0.18) decrease in L/S ratio was 1.40 (95% CI 1.02-1.92). We still found the significant results that L/S ratio was associated with the development of diabetes in the stratified analysis.

Conclusions: The ratio of liver to spleen for CT attenuation value was associated with the development of diabetes during 5 years regardless of BMI in Japanese community-based study.