Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Int J Clin Pract. 2021 Jun;75(6):e14131. doi: 10.1111/ijcp.14131. Epub 2021 Mar 21.
Obesity and dyslipidaemia are the major risk factors for non-alcoholic fatty liver disease (NAFLD), and are known to increase cardiovascular disease (CVD), which is the leading cause of death in NAFLD patients. The present cross-sectional study aimed to investigate associations among severity of hepatic steatosis, NAFLD fibrosis score and atherogenic lipid profile.
A total of 265 patients with NAFLD confirmed by ultrasonographic findings were included. The NAFLD fibrosis score and the fibrosis-4 (FIB-4) index were used to classify the probability of fibrosis as low, intermediate and high probability. Serum lipids including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were measured, and then TC/HDL-C, LDL-C/HDL-C, TG/HDL-C and non HDL-C/HDL-C ratios were determined. Fasting blood sugar (FBS), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were also assessed. The homeostatic model assessment for insulin resistance (HOMA-IR) was calculated.
The severity of hepatic steatosis was positively correlated with TC/HDL-C (r = 0.29, P = .002), LDL-C/HDL-C (r = 0.32, P < .001), TG/HDL-C (r = 0.36, P < .001) and non-HDL-C/HDL-C (r = 0.24, P = .001) ratios. Similarly, these parameters were positively correlated with NAFLD fibrosis score and FIB-4 index (P < .05). In addition, alanine aminotransferase and aspartate aminotransferase levels were positively correlated with TG/HDL-C ratio (r = 0.31, P = .003; and r = 0.27, P = .001 respectively). With increasing the severity of hepatic steatosis and NAFLD fibrosis score, the mean of all lipid ratios increased significantly (P < .01 and P < .05, respectively). Importantly, after controlling for potential confounders including age, gender, physical activity level, body mass index, waist circumference and HOMA-IR, the severity of steatosis, NAFLD fibrosis score and FIB-4 index remained independent predictors of atherogenic lipid profile.
Severity of hepatic steatosis, NAFLD fibrosis score and FIB-4 index were significantly correlated with atherogenic lipid profile. As NAFLD is high among patients with metabolic risk factors for CVD, their dyslipidaemia should be aggressively managed.
肥胖和血脂异常是非酒精性脂肪性肝病（NAFLD）的主要危险因素，已知它们会增加心血管疾病（CVD）的风险，而 CVD 是 NAFLD 患者的主要死亡原因。本横断面研究旨在探讨肝脂肪变性严重程度、NAFLD 纤维化评分和致动脉粥样硬化脂质谱之间的关系。
共纳入 265 例经超声检查证实的 NAFLD 患者。使用 NAFLD 纤维化评分和纤维化 4 指数（FIB-4）将纤维化概率分为低、中、高概率。检测总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）等血清脂质，然后测定 TC/HDL-C、LDL-C/HDL-C、TG/HDL-C 和非 HDL-C/HDL-C 比值。还评估了空腹血糖（FBS）、丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）。计算胰岛素抵抗的稳态模型评估（HOMA-IR）。
肝脂肪变性严重程度与 TC/HDL-C（r=0.29，P=0.002）、LDL-C/HDL-C（r=0.32，P<0.001）、TG/HDL-C（r=0.36，P<0.001）和非 HDL-C/HDL-C（r=0.24，P=0.001）比值呈正相关。同样，这些参数与 NAFLD 纤维化评分和 FIB-4 指数呈正相关（P<0.05）。此外，丙氨酸氨基转移酶和天冬氨酸氨基转移酶水平与 TG/HDL-C 比值呈正相关（r=0.31，P=0.003；r=0.27，P=0.001）。随着肝脂肪变性严重程度和 NAFLD 纤维化评分的增加，所有脂质比值的平均值显著增加（P<0.01 和 P<0.05，分别）。重要的是，在控制包括年龄、性别、体力活动水平、体重指数、腰围和 HOMA-IR 在内的潜在混杂因素后，脂肪变性严重程度、NAFLD 纤维化评分和 FIB-4 指数仍然是致动脉粥样硬化脂质谱的独立预测因子。
肝脂肪变性严重程度、NAFLD 纤维化评分和 FIB-4 指数与致动脉粥样硬化脂质谱显著相关。由于代谢性 CVD 危险因素患者中 NAFLD 发生率较高，应积极控制其血脂异常。
