Department of medicine, Graduate school, Inje University College of Medicine, Busan, Korea.
Department of Internal Medicine, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, #1435, Jwa-dong, Haeundae-gu, Busan, 612-030, Korea.
J Affect Disord. 2021 Jan 1;278:259-263. doi: 10.1016/j.jad.2020.09.073. Epub 2020 Sep 15.
It is unclear whether depression is linked to nonalcoholic fatty liver disease (NAFLD). The purpose of this study was to examine the association between depression and NAFLD and whether the association is partly explained by insulin resistance or inflammation.
Subjects consisted of 4,688 adults who participated in the 2016 Korea National Health and Nutrition Examination Survey. Depression was defined by Patient Health Questionnaire-9 score ≥ 10 or a previous diagnosis of depression. NAFLD was defined by hepatic steatosis index >36. Insulin resistance was assessed by triglycerides and glucose (TyG) index. Inflammation was measured with C-reactive protein (CRP).
Depression had a significant association with TyG index (p = 0.005), but not with CRP. Depression was a significant predictor of NAFLD (OR = 1.63; 95% CI, 1.26-2.10; p < 0.001). Adjustment for sociodemographic features and waist circumference did not substantially affect the results. Further adjustment for comorbidities reduced the estimate for depression by 23% (OR = 1.56; 95% CI, 1.18-2.06; p = 0.002). Inclusion of CRP in a fully adjusted model did not affect the results. Addition of the TyG index decreased the estimate for depression by 28% (OR = 1.39; 95% CI, 0.88-2.19; p = 0.161), and the resulting estimate became no longer significant. The TyG index remained the independent predictor of outcome.
The absence of a structured diagnostic interview for depression and histological diagnosis of NAFLD.
These data support an association of depression with NAFLD. Insulin resistance seems to play a major role in modulating the association between depression and NAFLD risk.
目前尚不清楚抑郁是否与非酒精性脂肪性肝病（NAFLD）有关。本研究旨在探讨抑郁与 NAFLD 之间的关联，以及这种关联是否部分是由胰岛素抵抗或炎症引起的。
研究对象为参加 2016 年韩国国家健康和营养检查调查的 4688 名成年人。抑郁的定义为患者健康问卷-9 评分≥10 分或有抑郁病史。NAFLD 的定义为肝脂肪变性指数>36。胰岛素抵抗通过甘油三酯和葡萄糖（TyG）指数评估。炎症用 C 反应蛋白（CRP）测量。
抑郁与 TyG 指数有显著相关性（p=0.005），但与 CRP 无关。抑郁是 NAFLD 的一个显著预测因子（OR=1.63；95%CI，1.26-2.10；p<0.001）。调整社会人口特征和腰围后，结果基本不变。进一步调整合并症会使抑郁的估计值降低 23%（OR=1.56；95%CI，1.18-2.06；p=0.002）。在完全调整模型中纳入 CRP 不会影响结果。加入 TyG 指数会使抑郁的估计值降低 28%（OR=1.39；95%CI，0.88-2.19；p=0.161），且结果不再显著。TyG 指数仍然是结果的独立预测因子。
缺乏针对抑郁的结构化诊断访谈和 NAFLD 的组织学诊断。
这些数据支持抑郁与 NAFLD 之间存在关联。胰岛素抵抗似乎在调节抑郁与 NAFLD 风险之间的关联中起主要作用。
