Associations Of Serum Fibroblast Growth Factor 23 Levels With Lower Extremity Atherosclerotic Disease And Non-Alcoholic Fatty Liver Disease In Type 2 Diabetes

Objective: The goal of this study was to investigate the relationship between serum fibroblast growth factor(FGF)23 levels,lower extremity atherosclerotic disease(LEAD),and non-alcoholic fatty liver disease(NAFLD),as well as the related factors,in Chinese patients with type 2 diabetes mellitus.Methods: Subjects with type 2 diabetes mellitus who were admitted into the Department of Endocrinology and Metabolism of Shanghai Jiao Tong University Affiliated Sixth People's Hospital were enrolled in the present study.Serum FGF23 levels were determined by a sandwich enzyme-linked immunosorbent assay.Serum FGF23 levels were measured using a sandwich enzyme-linked immunosorbent assay.Serum 25-hydroxyvitamin D [25(OH)D] levels were determined by an electrochemiluminescence immunoassay.Femoral intima-media thickness(F-IMT),lower limb atherosclerotic plaque,and NAFLD were assessed through ultrasound.Results:(1)In a total of 401 hospitalized type 2 diabetes patients,Subjects with LEAD had significantly higher serum FGF23 levels compared with those without LEAD(P<0.001).Logistic regression showed that serum FGF23 levels were independently and positively correlated with the presence of LEAD(P=0.004).In addition,multiple liner regression analysis showed that serum FGF23 levels were positively associated with F-IMT(P<0.001).Furthermore,this relationship remained significant after additional adjustment for gender and factors potentially affecting serum FGF23 levels(serum calcium,serum phosphorus,and glomerular filtration rate),respectively(P<0.01).(2)Among 331 hospitalized type 2 diabetes patients,subjects with NAFLD had significantly higher serum FGF23 levels(P<0.01),but lower serum 25(OH)D levels(P<0.01)thanthose without NAFLD.Moreover,the incidence rate of NAFLD increased with increasing serum FGF23 levels and decreased with increasing 25(OH)D levels(both P<0.05).Logistic regression analysis showed that both serum FGF23 and 25(OH)D levels were independent factors for NAFLD(both P<0.05).Furthermore,a multiple stepwise regression analysis also revealed that both serum FGF23 and 25(OH)D levels were independently correlated with fatty liver index(both P<0.01).Conclusions: In type 2 diabetes patients,serum FGF23 levels were independently and positively correlated with the presence of LEAD.In addition,both high FGF23 and low 25(OH)D levels showed an independent relationship with NAFLD.