Sevilla, Spain.
Valladolid, Spain.
Aliment Pharmacol Ther. 2018 Dec;48(11-12):1260-1270. doi: 10.1111/apt.15015. Epub 2018 Oct 23.
Metabolically healthy obesity (MHO) shows a reduced risk compared with obese patients with adverse metabolic conditions. Lean people suffering some metabolic derangements also have non-alcoholic fatty liver disease (NAFLD)-related outcomes compared with non-obese subjects with a few metabolic risks.
To define the impact of the metabolic status on the NAFLD-related outcomes, beyond the presence of obesity.
We designed a multicentre cross-sectional study, including 1058 biopsy-proven NAFLD patients. Metabolically healthy status was strictly defined by the lack of metabolic risk factors (diabetes mellitus, low HDL, hypertriglyceridemia, arterial hypertension). Non-alcoholic steatohepatitis (NASH) and significant fibrosis (F2-F4) were identified by liver biopsy. Chronic kidney disease epidemiology collaboration equation was calculated for kidney function and the atherogenic index of plasma (AIP) for cardiovascular risk.
Metabolically healthy (OR 1.88; P = 0.050) and unhealthy obesity (OR 3.47: P < 0.0001), and unhealthy non-obesity (OR 3.70; P < 0.0001) were independently associated with NASH together with homeostatic model assessment (HOMA), ALT, and platelets. Significant fibrosis was more frequently observed in the presence of adverse metabolic conditions in obese (OR 3.89; P = 0.003) and non-obese patients (OR 3.92; P = 0.002), and independently associated with platelets, albumin, ALT, HOMA, and age. The number of metabolic factors determined the risk of NASH and significant fibrosis. Glomerular filtration rate was lower in unhealthy (91.7 ± 18) than healthy metabolism (95.6 ± 17) (P = 0.007). AIP was higher in adverse metabolic conditions (P = 0.0001). Metabolically unhealthy non-obesity showed higher liver damage (NASH 55.8% vs 42.4%; P < 0.05; significant fibrosis 31.7% vs 11.4%; P < 0.0001) and cardiovascular risk (P < 0.0001) than healthy obesity.
Metabolic unhealthy status showed a greater impact on NASH, significant fibrosis, kidney dysfunction, and atherogenic profile than obesity. However, metabolically healthy obesity was not a full healthy condition. We should focus our messages especially on patients with adverse metabolic conditions.
与代谢异常的肥胖患者相比，代谢健康型肥胖（MHO）显示出较低的风险。与少数代谢风险的非肥胖受试者相比，患有一些代谢紊乱的瘦人也会出现非酒精性脂肪性肝病（NAFLD）相关的结果。
定义代谢状态对 NAFLD 相关结果的影响，而不仅仅是肥胖的存在。
我们设计了一项多中心横断面研究，纳入了 1058 例经肝活检证实的 NAFLD 患者。代谢健康状态是通过缺乏代谢危险因素（糖尿病、低 HDL、高甘油三酯血症、动脉高血压）来严格定义的。非酒精性脂肪性肝炎（NASH）和显著纤维化（F2-F4）通过肝活检确定。慢性肾脏病流行病学合作方程用于评估肾功能，血浆致动脉粥样硬化指数（AIP）用于评估心血管风险。
代谢健康（OR 1.88；P=0.050）和代谢不健康性肥胖（OR 3.47：P<0.0001）以及代谢不健康性非肥胖（OR 3.70；P<0.0001）与稳态模型评估（HOMA）、ALT 和血小板一起与 NASH 独立相关。在肥胖（OR 3.89；P=0.003）和非肥胖患者（OR 3.92；P=0.002）中，存在不良代谢状况时更常观察到显著纤维化，且与血小板、白蛋白、ALT、HOMA 和年龄独立相关。代谢因素的数量决定了 NASH 和显著纤维化的风险。不健康代谢组的肾小球滤过率（91.7±18）低于健康代谢组（95.6±17）（P=0.007）。AIP 在不良代谢条件下更高（P=0.0001）。代谢不健康性非肥胖者的肝损伤（NASH 55.8%比 42.4%；P<0.05；显著纤维化 31.7%比 11.4%；P<0.0001）和心血管风险（P<0.0001）均高于健康肥胖者。
与肥胖相比，代谢不健康状态对 NASH、显著纤维化、肾功能障碍和致动脉粥样硬化特征的影响更大。然而，代谢健康型肥胖并不是完全健康的状态。我们应该特别关注有不良代谢状况的患者。
