Department of Gastroenterology, Massachusetts General Hospital, Boston, MA 02114, USA.
Hepatology. 2010 Jun;51(6):1979-87. doi: 10.1002/hep.23593.
Obesity is not uniformly associated with the development of metabolic sequelae. Specific patterns of body fat distribution, in particular fatty liver, may preferentially predispose at-risk individuals to disease. In this study, we characterize the metabolic correlates of fat in the liver in a large community-based sample with and without respect to visceral fat. Fatty liver was measured by way of multidetector computed tomography of the abdomen in 2,589 individuals from the community-based Framingham Heart Study. Logistic and linear regression were used to determine the associations of fatty liver with cardio-metabolic risk factors adjusted for covariates with and without adjustment for other fat depots (body mass index, waist circumference, and visceral adipose tissue). The prevalence of fatty liver was 17%. Compared with participants without fatty liver, individuals with fatty liver had a higher adjusted odds ratio (OR) of diabetes (OR 2.98, 95% confidence interval [CI] 2.12-4.21), metabolic syndrome (OR 5.22, 95% CI 4.15-6.57), hypertension (OR 2.73, 95% CI 2.16-3.44), impaired fasting glucose (OR 2.95, 95% CI 2.32-3.75), insulin resistance (OR 6.16, 95% CI 4.90-7.76); higher triglycerides, systolic blood pressure (SBP), and diastolic blood pressure (DBP); and lower high-density lipoprotein (HDL) and adiponectin levels (P < 0.001 for all). After adjustment for other fat depots, fatty liver remained associated with diabetes, hypertension, impaired fasting glucose, metabolic syndrome, HDL, triglycerides, and adiponectin levels (all P < 0.001), whereas associations with SBP and DBP were attenuated (P > 0.05).
Fatty liver is a prevalent condition and is characterized by dysglycemia and dyslipidemia independent of visceral adipose tissue and other obesity measures. This work begins to dissect the specific links between fat depots and metabolic disease.
目的：肥胖并不总是与代谢后遗症的发生相关。特定的体脂分布模式，尤其是脂肪肝，可能会使高危人群更容易患上疾病。本研究旨在描述在一个基于社区的大样本中，不论是否存在内脏脂肪，肝脏脂肪与代谢相关因素的关系。
方法：通过对来自社区为基础的弗雷明汉心脏研究的 2589 名个体进行腹部多排螺旋 CT 检查，测量脂肪肝。采用逻辑和线性回归方法，分别在调整协变量和不调整其他脂肪组织（体重指数、腰围和内脏脂肪组织）的情况下，确定脂肪肝与心血管代谢危险因素的相关性。
结果：脂肪肝的患病率为 17%。与无脂肪肝的个体相比，有脂肪肝的个体调整后的糖尿病比值比（OR）更高（OR 2.98，95%可信区间[CI] 2.12-4.21）、代谢综合征（OR 5.22，95%CI 4.15-6.57）、高血压（OR 2.73，95%CI 2.16-3.44）、空腹血糖受损（OR 2.95，95%CI 2.32-3.75）、胰岛素抵抗（OR 6.16，95%CI 4.90-7.76）；甘油三酯、收缩压（SBP）和舒张压（DBP）更高；高密度脂蛋白（HDL）和脂联素水平更低（所有 P<0.001）。调整其他脂肪组织后，脂肪肝仍与糖尿病、高血压、空腹血糖受损、代谢综合征、HDL、甘油三酯和脂联素水平相关（所有 P<0.001），而与 SBP 和 DBP 的相关性减弱（P>0.05）。
结论：脂肪肝是一种常见的疾病，其特点是血糖和血脂异常，与内脏脂肪组织和其他肥胖测量无关。本研究开始剖析脂肪组织与代谢疾病之间的具体联系。
