基于社区的体质量指数对非酒精性脂肪性肝病进行风险分层。
Risk stratification of non-alcoholic fatty liver disease across body mass index in a community basis.
机构信息
Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
出版信息
J Formos Med Assoc. 2020 Jan;119(1 Pt 1):89-96. doi: 10.1016/j.jfma.2019.03.014. Epub 2019 Apr 2.
BACKGROUND
The features and risk analysis of non-alcoholic fatty liver disease (NAFLD) in a community-based setting remain elusive. The predictors between obese and lean subjects need further clarification. We aimed to assess the characteristics of NAFLD during a community screening. The associated metabolic abnormalities and cardiovascular risk assessment were also analyzed.
METHODS
A total of 2483 subjects receiving multi-purpose health screening at 10 primary care centers were recruited. They received clinical assessment, including demographic data, laboratory examination, and abdominal sonography.
RESULTS
The prevalence of NAFLD and metabolic syndrome were 44.5%, and 15.8%, respectively. Among those NAFLD subjects, 1212 (48.8%) subjects were obese (BMI≥ 24 kg/m). There was an increasing trend of NAFLD according to age, ranging from 25.8% of those aged <30 years to 54.4% of those aged 50-70 years (P for trend< 0.0001). High insulin resistance (IR) was the significant predictive factor for NAFLD in both obese (odds ratio [OR] = 3.85, 95% confidence interval [CI] = 1.87-8.36, P = 0.0002) and lean subjects (OR = 2.52, 95% CI = 1.13-5.54, p = 0.02). The prevalence of high Framingham Risk Score (≥7.5%) was 56.7% (211/372) among the male subjects, which was significantly higher than that (26%, 191/734) of the females (P < 0.001). There was a significant increase of high Framingham Risk Score according to BMI, ranging from 23.1% of BMI<24 kg/m to 45% of BMI>27 kg/m (P for trend< 0.0001).
CONCLUSION
IR is predictive of NAFLD irrespective of BMI. The cardiovascular risk may exist in lean NAFLD subjects.
背景
非酒精性脂肪性肝病（NAFLD）在社区人群中的特征和风险分析仍不清楚。肥胖和非肥胖人群之间的预测因素仍需进一步阐明。本研究旨在评估社区筛查中 NAFLD 的特征。同时分析其相关的代谢异常和心血管风险评估。
方法
共纳入 10 个基层医疗中心的 2483 名接受多用途健康筛查的受试者。他们接受了临床评估，包括人口统计学数据、实验室检查和腹部超声检查。
结果
NAFLD 和代谢综合征的患病率分别为 44.5%和 15.8%。在这些 NAFLD 患者中，1212 名（48.8%）患者为肥胖（BMI≥24kg/m）。随着年龄的增长，NAFLD 的患病率呈上升趋势，从<30 岁的 25.8%到 50-70 岁的 54.4%（趋势 P<0.0001）。高胰岛素抵抗（IR）是肥胖和非肥胖人群中 NAFLD 的显著预测因素（肥胖者的比值比 [OR]为 3.85，95%置信区间 [CI]为 1.87-8.36，P=0.0002；非肥胖者的 OR 为 2.52，95%CI 为 1.13-5.54，P=0.02）。在男性受试者中，高 Framingham 风险评分（≥7.5%）的患病率为 56.7%（211/372），明显高于女性（26%，191/734）（P<0.001）。随着 BMI 的增加，高 Framingham 风险评分呈显著上升趋势，从 BMI<24kg/m 的 23.1%到 BMI>27kg/m 的 45%（趋势 P<0.0001）。
结论
IR 可预测无论 BMI 如何的 NAFLD。瘦型 NAFLD 患者可能存在心血管风险。
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