Unalp-Arida Aynur, Ruhl Constance E
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland.
Social & Scientific Systems, Inc, Silver Spring, Maryland.
Clin Gastroenterol Hepatol. 2022 Apr;20(4):e808-e830. doi: 10.1016/j.cgh.2021.02.009. Epub 2021 Feb 5.
BACKGROUND & AIMS: We examined transient elastography assessed hepatic steatosis and fibrosis distributions and relationships with body composition in a representative United States population sample.
Liver stiffness and controlled attenuation parameter (CAP) were assessed on 4870 non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic men and women aged 20 years and over in the National Health and Nutrition Examination Survey (NHANES) 2017-2018. Participants underwent anthropometry and dual-energy x-ray absorptiometry (DXA).
Compared to women, men had higher mean CAP (274.2 dB/m vs 254.4 dB/m) and liver stiffness (6.4 kPa vs 5.5 kPa). CAP and liver stiffness increased through middle age and markedly with BMI. In multivariate-adjusted analysis, CAP in the upper quartile was associated with increased age, BMI, waist-to-hip ratio, diabetes, hypertension, alanine aminotransferase (ALT) and C-reactive protein and decreased HDL cholesterol. After adjustment, non-Hispanic Blacks had lower CAP and non-Hispanic Asians had higher CAP. In multivariate-adjusted analysis, liver stiffness in the upper quartile was associated with male sex, increased age, BMI, diabetes, hepatitis C virus positivity, ALT and CAP. Lower stiffness among Non-Hispanic Asians was not significant after adjustment for BMI. DXA trunk and extremity fat mass were positively related to both CAP and liver stiffness with multivariate adjustment (P < .001 for each). Results were similar with CAP and liver stiffness as continuous characteristics.
In the United States population, increased anthropometric and DXA body composition measures were associated with higher CAP and liver stiffness. Racial-ethnic differences observed merit further research to elucidate the burden of obesity and liver health disparities.
我们在美国具有代表性的人群样本中，研究了通过瞬时弹性成像评估的肝脂肪变性和纤维化分布及其与身体成分的关系。
在2017 - 2018年美国国家健康与营养检查调查（NHANES）中，对4870名年龄在20岁及以上的非西班牙裔白人、非西班牙裔黑人、非西班牙裔亚洲人和西班牙裔男性及女性进行了肝脏硬度和受控衰减参数（CAP）评估。参与者接受了人体测量和双能X线吸收法（DXA）检查。
与女性相比，男性的平均CAP（274.2 dB/m对254.4 dB/m）和肝脏硬度（6.4 kPa对5.5 kPa）更高。CAP和肝脏硬度在中年期升高，并随体重指数（BMI）显著增加。在多变量调整分析中，处于上四分位数的CAP与年龄增加、BMI、腰臀比、糖尿病、高血压、丙氨酸氨基转移酶（ALT）和C反应蛋白升高以及高密度脂蛋白胆固醇降低相关。调整后，非西班牙裔黑人的CAP较低，而非西班牙裔亚洲人的CAP较高。在多变量调整分析中，处于上四分位数的肝脏硬度与男性、年龄增加、BMI、糖尿病、丙型肝炎病毒阳性、ALT和CAP相关。在对BMI进行调整后，非西班牙裔亚洲人较低的肝脏硬度不再显著。经多变量调整后，DXA测量的躯干和四肢脂肪量与CAP和肝脏硬度均呈正相关（每项P <.001）。将CAP和肝脏硬度作为连续特征时，结果相似。
在美国人群中，人体测量和DXA测量的身体成分增加与更高的CAP和肝脏硬度相关。观察到的种族差异值得进一步研究，以阐明肥胖负担和肝脏健康差异。
