Onat Altan, Can Günay, Kaya Ayşem, Akbaş Tuğba, Özpamuk-Karadeniz Fatma, Şimşek Barış, Çakır Hakan, Yüksel Hüsniye
Altan Onat, Hüsniye Yüksel, Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, 34099 Istanbul, Turkey.
World J Gastroenterol. 2015 Dec 28;21(48):13555-65. doi: 10.3748/wjg.v21.i48.13555.
To assess the association of a surrogate of fatty liver disease (FLD) with incident type-2 diabetes, coronary heart disease, and all-cause mortality.
In a prospective population-based study on 1822 middle-aged adults, stratified to gender, we used an algorithm of fatty liver index (FLI) to identify associations with outcomes. An index ≥ 60 indicated the presence of FLD. In Cox regression models, adjusted for age, smoking status, high-density lipoprotein cholesterol, and systolic blood pressure, we assessed the predictive value of FLI for incident diabetes, coronary heart disease (CHD), and all-cause mortality.
At a mean 8 year follow-up, 218 and 285 incident cases of diabetes and CHD, respectively, and 193 deaths were recorded. FLD was significantly associated in each gender with blood pressure, total cholesterol, apolipoprotein B, uric acid, and C-reactive protein; weakly with fasting glucose; and inversely with high-density lipoprotein-cholesterol and sex hormone-binding globulin. In adjusted Cox models, FLD was (with a 5-fold HR) the major determinant of diabetes development. Analyses further disclosed significant independent prediction of CHD by FLD in combined gender [hazard ratio (HR) = 1.72, 95% confidence interval (CI): 1.17-2.53] and men (HR = 2.35, 95%CI: 1.25-4.43). Similarly-adjusted models for all-cause mortality proved, however, not to confer risk, except for a tendency in prediabetics and diabetic women.
A surrogate of FLD conferred significant high risk of diabetes and coronary heart disease, independent of some metabolic syndrome traits. All-cause mortality was not associated with FLD, except likely in the prediabetic state. Such a FLI may reliably be used in epidemiologic studies.
评估脂肪肝疾病（FLD）替代指标与2型糖尿病、冠心病及全因死亡率之间的关联。
在一项针对1822名中年成年人的基于人群的前瞻性研究中，按性别分层，我们使用脂肪肝指数（FLI）算法来确定与结局的关联。指数≥60表明存在FLD。在Cox回归模型中，对年龄、吸烟状况、高密度脂蛋白胆固醇和收缩压进行校正后，我们评估了FLI对新发糖尿病、冠心病（CHD）和全因死亡率的预测价值。
在平均8年的随访中，分别记录了218例和285例新发糖尿病和冠心病病例以及193例死亡病例。在每种性别中，FLD均与血压、总胆固醇、载脂蛋白B、尿酸和C反应蛋白显著相关；与空腹血糖呈弱相关；与高密度脂蛋白胆固醇和性激素结合球蛋白呈负相关。在调整后的Cox模型中，FLD是糖尿病发生的主要决定因素（风险比为5倍）。分析进一步揭示，FLD在合并性别组[风险比（HR）=1.72，95%置信区间（CI）：1.17 - 2.53]和男性组（HR = 2.35，95%CI：1.25 - 4.43）中对冠心病具有显著的独立预测作用。然而，除了糖尿病前期和糖尿病女性有一定趋势外，针对全因死亡率的类似调整模型并未显示出风险。
FLD替代指标具有显著的糖尿病和冠心病高风险，独立于某些代谢综合征特征。除了可能在糖尿病前期状态外，全因死亡率与FLD无关。这样的FLI可可靠地用于流行病学研究。
