Fan Jian-gao, Zhou Qi, Wo Qian-hong
Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Zhonghua Gan Zang Bing Za Zhi. 2010 Sep;18(9):676-9. doi: 10.3760/cma.j.issn.1007-3418.2010.09.008.
To determine the effect of body mass index (BMI) at baseline and its change during follow-up on the incidence of non-alcoholic fatty liver diseases (NAFLD) in apparently healthy adults.
Subjects free of previous liver injury, alcohol consumption of more than 140 g/week and hepatitis B virus infection were identified from employees of Shanghai BaoSteel Group who underwent voluntary medical checkups at a 2-year interval. The analyzed population consisted of 5402 non-drinking subjects (4633 men) of age 36.5+/-9.3 years (18-65 years), who had normal livers at baseline. Among them 327 subjects (6.05%) developed fatty liver in 2 years. Those who developed NAFLD showed advanced age (especially in females), elevated BMI, high levels of serum triglyceride and total cholesterol, high prevalence rates of obesity, hyperlipidemia, hypertension and hyperglyceridemia at baseline, more weight gain and increase of serum triglycerides during the 2-year period. The incidence of NAFLD increased significantly with the changes of BMI at baseline, from 1.4% in subjects with normal weight, 6.4% in overweight, 16.8% in obese patients to 24.5% in severe obesity (Chi2 test = 389.01, P = 0.000 in trend analysis). Logistic regression analysis showed a significant interaction occurred between NAFLD age, BMI and serum triglyceride at baseline, and subtle gain of BMI and triglyceride during follow-up.
There is a high incidence of NAFLD in a Chinese workplace. Obesity and related metabolic disorders at baseline, and more weight gain and increased serum triglyceride during follow-up are important predictors for the development of NAFLD.
确定健康成年人基线时的体重指数(BMI)及其随访期间的变化对非酒精性脂肪性肝病(NAFLD)发病率的影响。
从上海宝钢集团每两年进行一次自愿体检的员工中,挑选出既往无肝损伤、每周饮酒量超过140克以及未感染乙肝病毒的受试者。分析人群包括5402名不饮酒的受试者(4633名男性),年龄为36.5±9.3岁(18 - 65岁),基线时肝脏正常。其中327名受试者(6.05%)在2年内出现脂肪肝。发生NAFLD的受试者在基线时表现为年龄较大(尤其是女性)、BMI升高、血清甘油三酯和总胆固醇水平升高、肥胖、高脂血症、高血压和高甘油三酯血症的患病率较高,在2年期间体重增加更多且血清甘油三酯升高。NAFLD的发病率随着基线BMI的变化而显著增加,从体重正常者的1.4%、超重者的6.4%、肥胖患者的16.8%到重度肥胖者的24.5%(趋势分析中卡方检验=389.01,P = 0.000)。逻辑回归分析显示,NAFLD、年龄、BMI和基线时的血清甘油三酯之间存在显著交互作用以及随访期间BMI和甘油三酯的细微增加。
中国职场人群中NAFLD的发病率较高。基线时的肥胖及相关代谢紊乱,以及随访期间更多的体重增加和血清甘油三酯升高是NAFLD发生的重要预测因素。