Zupo Roberta, Castellana Fabio, Panza Francesco, Castellana Marco, Lampignano Luisa, Cincione Raffaele Ivan, Triggiani Vincenzo, Giannelli Gianluigi, Dibello Vittorio, Sardone Rodolfo, De Pergola Giovanni
Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy.
Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy.
J Clin Med. 2021 Apr 15;10(8):1695. doi: 10.3390/jcm10081695.
Screening for non-alcoholic fatty liver disease (NAFLD) is key step for primary management of fatty liver in the clinical setting. Excess weight subjects carry a greater metabolic risk even before exhibiting pathological patterns, including diabetes. We characterized the cross-sectional relationship between routine circulating biomarkers and NAFLD in a large sample of diabetes-free subjects with overweight or obesity, to elucidate any independent relationship. A population sample of 1232 consecutive subjects with a body mass index of at least 25 kg/m, not receiving any drug or supplemental therapy, was studied. Clinical data and routine biochemistry were analyzed. NAFLD was defined using the validated fatty liver index (FLI), classifying subjects with a score ≥ 60% as at high risk. Due to extreme skewing of variables of interest, resampling matching for age and sex was performed. Our study population was characterized by a majority of females (69.90%) and a prevalence of NAFLD in males (88.90%). As a first step, propensity score matching was explicitly performed to balance the two groups according to the FLI cut-off. Based on the resulting statistical trajectories, corroborated even after data matching, we built two logistic regression models on the matched population ( = 732) to verify any independent association. We found that each unit increase of FT3 implicated a 50% increased risk of NAFLD (OR 1.506, 95%CI 1.064 to 2.131). When including glycated haemoglobin (HbA1c) in the model, free-triiodothyronine (FT3) lost significance (OR 1.557, 95%CI 0.784 to 3.089) while each unit increase in HbA1c (%) indicated a significantly greater NAFLD risk, by almost two-fold (OR 2.32, 95%CI 1.193 to 4.512). Glucose metabolism dominates a key pathway along the hazard trajectories of NAFLD, turned out to be key biomarker in monitoring the risk of fatty liver in diabetes-free overweight subjects. Each unit increase in HbA1c (%) indicated a significantly greater NAFLD risk, by almost two-fold, in our study.
非酒精性脂肪性肝病（NAFLD）筛查是临床环境中脂肪肝初级管理的关键步骤。超重受试者即使在出现包括糖尿病在内的病理模式之前，也面临更大的代谢风险。我们在大量无糖尿病的超重或肥胖受试者样本中，对常规循环生物标志物与NAFLD之间的横断面关系进行了特征分析，以阐明任何独立关系。对1232名连续的受试者进行了研究，这些受试者体重指数至少为25kg/m²，未接受任何药物或补充治疗。分析了临床数据和常规生化指标。使用经过验证的脂肪肝指数（FLI）定义NAFLD，将得分≥60%的受试者分类为高风险。由于感兴趣变量的极端偏态，对年龄和性别进行了重采样匹配。我们的研究人群以女性居多（69.90%），男性中NAFLD患病率较高（88.90%）。作为第一步，明确进行倾向得分匹配，以根据FLI临界值平衡两组。根据所得的统计轨迹，即使在数据匹配后也得到了证实，我们在匹配人群（n = 732）上建立了两个逻辑回归模型，以验证任何独立关联。我们发现，FT3每增加一个单位，NAFLD风险增加50%（OR 1.506，95%CI 1.064至2.131）。当模型中纳入糖化血红蛋白（HbA1c）时，游离三碘甲状腺原氨酸（FT3）失去显著性（OR 1.557，95%CI 0.784至3.089），而HbA1c（%）每增加一个单位，NAFLD风险显著增加近两倍（OR 2.32，95%CI 1.193至4.512）。葡萄糖代谢在NAFLD的风险轨迹中主导着一条关键途径，结果表明它是监测无糖尿病超重受试者脂肪肝风险的关键生物标志物。在我们的研究中，HbA1c（%）每增加一个单位，NAFLD风险显著增加近两倍。
