Feng Ren-Nan, Du Shan-Shan, Wang Cheng, Li Yan-Chuan, Liu Li-Yan, Guo Fu-Chuan, Sun Chang-Hao
Ren-Nan Feng, Shan-Shan Du, Yan-Chuan Li, Li-Yan Liu, Fu-Chuan Guo, Chang-Hao Sun, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, Heilongjiang Province, China.
World J Gastroenterol. 2014 Dec 21;20(47):17932-40. doi: 10.3748/wjg.v20.i47.17932.
To study the prevalence and clinical biochemical, blood cell and metabolic features of lean-non-alcoholic fatty liver disease (lean-NAFLD) and its association with other diseases.
Demographic, biochemical and blood examinations were conducted in all the subjects in this study. We classified the subjects into four groups according to their weight and NAFLD status: lean-control, lean-NAFLD [body mass index (BMI) < 24 kg/m(2)], overweight-obese control and overweight-obese NAFLD. One-way analysis of variance (ANOVA) was used to compare the means of continuous variables (age, BMI, blood pressure, glucose, lipid, insulin, liver enzymes and blood cell counts) and the χ (2) test was used to compare the differences in frequency of categorical variables (sex, education, physical activity, smoking, alcohol consumption and prevalence of hypertension, hyperlipidemia, diabetes, metabolic syndrome central obesity and obesity). Both univariate and multivariate logistic regression models were adopted to calculate odds ratios (ORs) and predict hyperlipidemia, hypertension, diabetes and metabolic syndrome when we respectively set all controls, lean-control and overweight-obese-control as references. In multivariate logistic regression models, we adjusted potential confounding factors, including age, sex, smoking, alcohol consumption and physical activity.
The prevalence of NAFLD was very high in China. NAFLD patients were older, had a higher BMI, waist circumference, blood pressure, fasting blood glucose, insulin, blood lipid, liver enzymes and uric acid than the controls. Although lean-NAFLD patients had lower BMI and waist circumstance, they had significantly higher visceral adiposity index than overweight-obese controls. Lean-NAFLD patients had comparable triglyceride, cholesterin and low-density lipoprotein cholesterin to overweight-obese NAFLD patients. In blood cell examination, both lean and overweight-obese NAFLD was companied by higher white blood cell count, red blood cell count, hemoglobin and hematocrit value. All NAFLD patients were at risk of hyperlipidemia, hypertension, diabetes and metabolic syndrome (MetS). Lean-NAFLD was more strongly associated with diabetes (OR = 2.47, 95%CI: 1.14-5.35), hypertension (OR = 1.72, 95%CI: 1.00-2.96) and MetS (OR = 3.19, 95%CI: 1.17-4.05) than overweight-obese-NAFLD (only OR for MetS was meaningful: OR = 1.89, 95%CI: 1.29-2.77). NAFLD patients were more likely to have central obesity (OR = 1.97, 95%CI: 1.38-2.80), especially in lean groups (OR = 2.17, 95%CI: 1.17-4.05).
Lean-NAFLD has unique results in demographic, biochemical and blood examinations, and adds significant risk for diabetes, hypertension and MetS in lean individuals.
研究瘦型非酒精性脂肪性肝病（lean-NAFLD）的患病率、临床生化、血细胞及代谢特征及其与其他疾病的关联。
对本研究中的所有受试者进行人口统计学、生化及血液检查。根据体重和NAFLD状态将受试者分为四组：瘦型对照组、瘦型NAFLD组[体重指数（BMI）<24kg/m²]、超重肥胖对照组和超重肥胖NAFLD组。采用单因素方差分析（ANOVA）比较连续变量（年龄、BMI、血压、血糖、血脂、胰岛素、肝酶和血细胞计数）的均值，采用χ²检验比较分类变量（性别、教育程度、体力活动、吸烟、饮酒以及高血压、高脂血症、糖尿病、代谢综合征、中心性肥胖和肥胖的患病率）的频率差异。分别将所有对照组、瘦型对照组和超重肥胖对照组作为参照，采用单因素和多因素逻辑回归模型计算比值比（OR）并预测高脂血症、高血压、糖尿病和代谢综合征。在多因素逻辑回归模型中，对潜在混杂因素进行了校正，包括年龄、性别、吸烟、饮酒和体力活动。
NAFLD在中国的患病率很高。NAFLD患者比对照组年龄更大，BMI、腰围、血压、空腹血糖、胰岛素、血脂、肝酶和尿酸更高。尽管瘦型NAFLD患者的BMI和腰围较低，但他们的内脏脂肪指数显著高于超重肥胖对照组。瘦型NAFLD患者的甘油三酯、胆固醇和低密度脂蛋白胆固醇与超重肥胖NAFLD患者相当。在血细胞检查中，瘦型和超重肥胖NAFLD患者的白细胞计数、红细胞计数、血红蛋白和血细胞比容值均较高。所有NAFLD患者均有患高脂血症、高血压、糖尿病和代谢综合征（MetS）的风险。与超重肥胖NAFLD相比，瘦型NAFLD与糖尿病（OR = 2.47，95%CI：1.14 - 5.35）、高血压（OR = 1.72，95%CI：1.00 - 2.96）和MetS（OR = 3.19，95%CI：1.17 - 4.05）的关联更强（超重肥胖NAFLD仅MetS的OR有意义：OR = 1.89，95%CI：1.29 - 2.77）。NAFLD患者更易发生中心性肥胖（OR = 1.97，95%CI：1.38 - 2.80），尤其是在瘦型组（OR = 2.17，95%CI：1.17 - 4.05）。
瘦型NAFLD在人口统计学、生化及血液检查中有独特表现，且增加了瘦型个体患糖尿病、高血压和MetS的显著风险。
