Golabi Pegah, Otgonsuren Munkhzul, de Avila Leyla, Sayiner Mehmet, Rafiq Nila, Younossi Zobair M
Betty and Guy Beatty Center for Integrated Research, Inova Health System Center for Liver Disease, Department of Medicine, Inova Fair, Falls Church, VA.
Medicine (Baltimore). 2018 Mar;97(13):e0214. doi: 10.1097/MD.0000000000010214.
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the United States. Metabolic syndrome (MS) components are highly prevalent in NAFLD. Our aim is to assess the relationship of NAFLD and MS with long-term outcome of mortality.The Third National Health and Nutrition Examination Survey (NHANES) was utilized. NAFLD was diagnosed by ultrasound in the presence of hepatic steatosis and no other causes of chronic liver disease. History of MS and its components were obtained from self-reported NHANES questionnaires. Mortality was obtained from Mortality-Linkage File, through December 31, 2011. Chi-square test was used for categorical variables and Cox proportional models estimated hazard ratios with 95% confidence interval.NAFLD cohort (n = 3613) had a median age of 43 years, 73% white, and 50% male. NAFLD group with at least one MS condition was significantly older, had higher body mass index, more likely to have insulin resistance, and heart disease compared to NAFLD group without MS. Over 19-years of follow-up, 1039 people died. Compared to NAFLD patients without MS, presence of one MS component increased the risk of mortality at 8-year (2.6% vs 4.7%) and 16-year (6% vs 11.9%) (P < .001). After adjusting for socio-demographic factors, NAFLD with all MS components was associated with overall, cardiac and liver-mortality. Increased number of MS components was associated with lower survival (P < .0001).Patients with NAFLD and MS have higher mortality risk compared to NAFLD patients without MS. These NAFLD patients should be prioritized for the development of treatment regimens.
非酒精性脂肪性肝病（NAFLD）是美国慢性肝病最常见的病因。代谢综合征（MS）的各组分在NAFLD中高度流行。我们的目的是评估NAFLD和MS与长期死亡结局之间的关系。我们利用了第三次全国健康和营养检查调查（NHANES）。通过超声诊断NAFLD，要求存在肝脂肪变性且无其他慢性肝病病因。MS及其各组分的病史通过NHANES的自填问卷获得。通过死亡率关联文件获取截至2011年12月31日的死亡率。分类变量采用卡方检验，Cox比例模型估计风险比及95%置信区间。
NAFLD队列（n = 3613）的中位年龄为43岁，73%为白人，50%为男性。与无MS的NAFLD组相比，至少有一种MS情况的NAFLD组年龄显著更大，体重指数更高，更易出现胰岛素抵抗和心脏病。在超过19年的随访中，有1039人死亡。与无MS的NAFLD患者相比，存在一种MS组分使8年（2.6%对4.7%）和16年（6%对11.9%）的死亡风险增加（P <.001）。在调整社会人口统计学因素后，具有所有MS组分的NAFLD与全因死亡、心脏死亡和肝脏死亡相关。MS组分数量增加与生存率降低相关（P <.0001）。
与无MS的NAFLD患者相比，患有NAFLD和MS的患者死亡风险更高。这些NAFLD患者应优先制定治疗方案。
