Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.
Liver Int. 2017 Nov;37(11):1715-1722. doi: 10.1111/liv.13478. Epub 2017 Jun 10.
This study investigated incidence and risk factors for NAFLD among an adult cohort with 7-year follow-up.
The study population (age-stratified random sampling, Ragama MOH area) was screened initially in 2007 (aged 35-64 years) and re-evaluated in 2014 (aged 42-71 years). On both occasions assessed by structured interview, anthropometric measurements, liver ultrasound, biochemical and serological tests. NAFLD was diagnosed on ultrasound criteria, safe alcohol consumption and absence of hepatitis B/C markers. Non-NAFLD controls did not have any ultrasound criteria for NAFLD. An updated case-control genetic association study for 10 selected genetic variants and NAFLD was also performed.
Out of 2985 of the original cohort, 2148 (72.0%) attended follow-up (1238 [57.6%] women; mean-age 59.2 [SD-7.6] years) in 2014, when 1320 (61.5%) were deemed NAFLD subjects. Out of 778 who initially did not have NAFLD and were not heavy drinkers throughout follow-up, 338 (43.4%) (221 [65.4%] women, mean-age 57.8 [SD-8.0] years) had developed NAFLD after 7-years (annual incidence-6.2%). Central obesity (OR=3.82 [95%-CI 2.09-6.99]), waist increase >5% (OR=2.46 [95%-CI 1.20-5.05]) overweight (OR=3.26 [95%-CI 1.90-5.60]), weight gain 5%-10% (OR=5.70 [95%-CI 2.61-12.47]), weight gain >10% (OR=16.94 [95%-CI 6.88-41.73]), raised plasma triglycerides (OR=1.96 [95%-CI 1.16-3.29]) and diabetes (OR=2.14 [95%-CI 1.13-4.06]), independently predicted the development of incident NAFLD in multivariate analysis. The updated genetic association study (1362-cases, 392-controls) showed replicated association (P=.045, 1-tailed) with NAFLD at a candidate locus: PNPLA3 (rs738409).
In this community cohort study, the annual incidence of NAFLD was 6.2%. Incident NAFLD was associated with general and central obesity, raised triglycerides and diabetes, and showed a tendency of association with PNPLA3 gene polymorphisms.
本研究通过对随访 7 年的成年队列进行研究，调查非酒精性脂肪性肝病（NAFLD）的发病率和危险因素。
研究人群（分层随机抽样，拉嘎马莫卫生局地区）最初于 2007 年（35-64 岁）进行筛查，并于 2014 年（42-71 岁）重新评估。两次均通过结构化访谈、人体测量、肝脏超声、生化和血清学检查进行评估。根据超声标准、安全饮酒和无乙型肝炎/丙型肝炎标志物诊断 NAFLD。非 NAFLD 对照组没有任何超声标准的 NAFLD。还对 10 个选定的遗传变异和 NAFLD 进行了更新的病例对照遗传关联研究。
在最初的 2985 名队列中，有 2148 名（72.0%）参加了 2014 年的随访（女性 1238 名[57.6%]；平均年龄 59.2 [SD-7.6]岁），其中 1320 名（61.5%）被认为是 NAFLD 患者。在最初没有 NAFLD 且整个随访期间没有大量饮酒的 778 名患者中，有 338 名（43.4%）（女性 221 名[65.4%]，平均年龄 57.8 [SD-8.0]岁）在 7 年后发展为 NAFLD（年发病率为 6.2%）。中心性肥胖（OR=3.82[95%CI 2.09-6.99]）、腰围增加>5%（OR=2.46[95%CI 1.20-5.05]）、超重（OR=3.26[95%CI 1.90-5.60]）、体重增加 5%-10%（OR=5.70[95%CI 2.61-12.47]）、体重增加>10%（OR=16.94[95%CI 6.88-41.73]）、血浆甘油三酯升高（OR=1.96[95%CI 1.16-3.29]）和糖尿病（OR=2.14[95%CI 1.13-4.06]）在多变量分析中独立预测了 NAFLD 的发生。更新后的遗传关联研究（1362 例病例，392 例对照）显示候选基因座：PNPLA3（rs738409）与 NAFLD 具有复制关联（P=.045，单侧）。
在这项社区队列研究中，NAFLD 的年发病率为 6.2%。新发 NAFLD 与全身和中心性肥胖、甘油三酯升高和糖尿病有关，并与 PNPLA3 基因多态性呈趋势相关。
