Golabi Pegah, Paik James M, Arshad Tamoore, Younossi Youssef, Mishra Alita, Younossi Zobair M
Betty and Guy Beatty Center for Integrated Research, Inova Health System Inova Health System Falls Church VA.
Center For Liver Diseases Department of Medicine Inova Fairfax Medical Campus Falls Church VA.
Hepatol Commun. 2020 May 19;4(8):1136-1148. doi: 10.1002/hep4.1534. eCollection 2020 Aug.
Although nonalcoholic fatty liver disease (NAFLD) is associated with obesity, it can also occur in lean and metabolically normal individuals. Our aim was to determine the effect of different combinations of abdominal adiposity and overall adiposity on the mortality of NAFLD. The Third National Health and Nutrition Examination Survey with mortality data from the National Death Index were used. NAFLD was defined as steatosis without other liver diseases. Body composition was categorized according to waist circumference (WC) and body mass index (BMI). Obesity pattern was defined according to BMI (lean, overweight, and obese) and WC (normal and obese) using accepted definitions. The "metabolically abnormal" group had visceral obesity, insulin resistance, type 2 diabetes, hypertension, or hyperlipidemia. Of the 9,341 study individuals (47.9% male; 76.8% white), NAFLD was present in 3,140 (33.6%), of whom 0.6% had lean BMI and normal WC, and 1.7% had lean BMI and obese WC. The prevalence of metabolically normal NAFLD was 3.26% (95% confidence interval [CI]: 2.62%-3.90%), with most of these subjects having lean BMI (79.2%). During an average follow-up of 22.4 years, 24.1% of the subjects died from all causes. Among these deceased individuals, 41.7% had NAFLD at baseline. Causes of death were cardiovascular disease (24.8%), cancer-related (24.3%), type 2 diabetes-related (4.4%), and liver-related (1.7%). Individuals with NAFLD who were lean by BMI but obese by WC had higher risk of all-cause mortality. Individuals with NAFLD with normal BMI but obese WC had a higher risk of cardiovascular mortality (hazard ratio 2.63 [95% CI: 1.15-6.01]) as compared with overweight (by BMI) NAFLD with normal WC. The risk of mortality in NAFLD can be affected by the presence of visceral obesity, especially in the lean BMI group. These data have important management implications for patients with NAFLD.
尽管非酒精性脂肪性肝病（NAFLD）与肥胖相关，但它也可能发生在体型消瘦和代谢正常的个体中。我们的目的是确定腹部肥胖和总体肥胖的不同组合对NAFLD死亡率的影响。我们使用了第三次全国健康和营养检查调查以及来自国家死亡指数的死亡率数据。NAFLD被定义为无其他肝脏疾病的脂肪变性。根据腰围（WC）和体重指数（BMI）对身体成分进行分类。肥胖模式根据BMI（消瘦、超重和肥胖）和WC（正常和肥胖）使用公认的定义来定义。“代谢异常”组有内脏肥胖、胰岛素抵抗、2型糖尿病、高血压或高脂血症。在9341名研究对象中（47.9%为男性；76.8%为白人），3140人（33.6%）患有NAFLD，其中0.6%的人BMI消瘦且WC正常，1.7%的人BMI消瘦但WC肥胖。代谢正常的NAFLD患病率为3.26%（95%置信区间[CI]：2.62%-3.90%），这些受试者大多BMI消瘦（79.2%）。在平均22.4年的随访期间，24.1%的受试者死于各种原因。在这些死亡个体中，41.7%在基线时患有NAFLD。死亡原因包括心血管疾病（24.8%）、癌症相关（24.3%）、2型糖尿病相关（4.4%）和肝脏相关（1.7%）。BMI消瘦但WC肥胖的NAFLD个体全因死亡风险更高。与WC正常的超重（按BMI）NAFLD个体相比，BMI正常但WC肥胖的NAFLD个体心血管死亡风险更高（风险比2.63[95%CI：1.15-6.01]）。NAFLD的死亡风险可能受内脏肥胖的影响，尤其是在BMI消瘦组。这些数据对NAFLD患者的管理具有重要意义。
