Division of Pediatric Endocrinology, Department of Pediatrics, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908 USA.
Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, 32608 USA.
Nutr Res. 2021 Apr;88:34-43. doi: 10.1016/j.nutres.2020.12.023. Epub 2020 Dec 26.
The obesity epidemic has increased risk for nonalcoholic fatty-liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), advanced fibrosis and cirrhosis. We hypothesized that metabolic syndrome (MetS) severity would correlate with markers of NAFLD and NASH fibrosis. We evaluated cross-sectional data from 5463 participants of the National Health and Nutrition Examination Survey 1999-2012, age 20 to 64 years with and without diabetes, excluding those with heavy drinking and infectious liver serologies. We used linear and logistic regression to evaluate links between MetS-severity (using a race/ethnicity-specific MetS-severity-Z-score, MetS-Z) and apparent NALFD sequelae, using elevated alanine aminotransferase (ALT) to determine presence of NAFLD and elevated NAFLD Fibrosis Score to identify advanced fibrosis (NASH Clinical Research Network scoring stage 3-4). The prevalence of unexplained ALT elevations and advanced fibrosis were 11.4% and 1.37%, respectively. MetS-Z-scores were higher among those with elevated ALT (0.7, 95% confidence interval [CI]: 0.6, 0.8) and advanced fibrosis (1.7, CI: 1.5,1.9), compared to those without liver abnormalities (0.2, CI:0.2, 0.3). For every 1-standard-deviation unit increase in MetS-Z, there were higher odds of elevated ALT (OR = 1.58, CI: 1.44, 1.72) and advanced fibrosis (OR = 1.96, CI: 1.77, 2.18), with some attenuation after adjustment for age, sex, race/ethnicity, and diabetes status. Significant differences were noted by race/ethnicity, with stronger links among whites versus blacks. The degree of MetS-severity was associated with progressive increase in apparent NAFLD and advanced fibrosis; as MetS-severity has also been linked to future cardiovascular disease, diabetes, and chronic kidney disease, this provides support for use of a MetS-severity score to screen for general health, with high levels triggering further assessment for liver abnormalities.
肥胖症的流行增加了非酒精性脂肪肝（NAFLD）、非酒精性脂肪性肝炎（NASH）、肝纤维化和肝硬化的风险。我们假设代谢综合征（MetS）的严重程度与 NAFLD 和 NASH 纤维化的标志物相关。我们评估了 1999-2012 年全国健康和营养调查（National Health and Nutrition Examination Survey）中 5463 名年龄在 20 至 64 岁的参与者的横断面数据，这些参与者没有糖尿病，排除了大量饮酒和传染性肝炎血清学的参与者。我们使用线性和逻辑回归来评估 MetS 严重程度（使用种族/民族特异性 MetS 严重程度-Z 评分，MetS-Z）与明显的 NAFLD 后果之间的联系，使用升高的丙氨酸氨基转移酶（ALT）来确定是否存在 NAFLD，使用升高的 NAFLD 纤维化评分来识别晚期纤维化（NASH 临床研究网络评分 3-4 期）。未明原因的 ALT 升高和晚期纤维化的患病率分别为 11.4%和 1.37%。与无肝脏异常者（0.2，CI：0.2，0.3）相比，ALT 升高（0.7，CI：0.6，0.8）和晚期纤维化（1.7，CI：1.5，1.9）者的 MetS-Z 评分更高。MetS-Z 每增加一个标准差，ALT 升高的几率就会更高（OR=1.58，CI：1.44，1.72），晚期纤维化的几率也会更高（OR=1.96，CI：1.77，2.18），但在调整年龄、性别、种族/民族和糖尿病状况后，这种相关性有所减弱。不同种族/民族之间存在显著差异，白种人比黑种人之间的相关性更强。MetS 严重程度与明显的 NAFLD 和晚期纤维化呈逐渐增加的关系；由于 MetS 严重程度也与未来的心血管疾病、糖尿病和慢性肾病有关，这为使用 MetS 严重程度评分来筛查整体健康状况提供了支持，高水平提示需要进一步评估肝脏异常。
