Harvard Medical School, Boston, MA, USA.
Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, USA.
Hepatol Commun. 2022 Feb;6(2):309-319. doi: 10.1002/hep4.1818. Epub 2021 Sep 2.
Nonalcoholic fatty liver disease (NAFLD) is independently associated with obesity and cardiovascular disease (CVD). CVD is the primary cause of mortality in the predominantly obese population of adults with NAFLD. NAFLD is increasingly seen in individuals who are lean and overweight (i.e., nonobese), but it is unclear whether their risk of CVD is comparable to those with NAFLD and obesity. Using a prospective cohort of patients with NAFLD, we compared the prevalence and incidence of CVD in individuals with and without obesity. NAFLD was diagnosed by biopsy or imaging after excluding other chronic liver disease etiologies. Logistic regression was used to compare the odds of baseline CVD by obesity status. Cox proportional hazards regression was used to evaluate obesity as a predictor of incident CVD and to identify predictors of CVD in subjects with and without obesity. At baseline, adults with obesity had a higher prevalence of CVD compared to those without obesity (12.0% vs. 5.0%, P = 0.02). During follow-up, however, obesity did not predict incident CVD (hazard ratio [HR], 1.24; 95% confidence interval [CI], 0.69-2.22) or other metabolic diseases. Findings were consistent when considering body mass index as a continuous variable and after excluding subjects who were overweight. Age (adjusted HR [aHR], 1.05; 95% CI, 1.03-1.08), smoking (aHR, 4.61; 95% CI, 1.89-11.22), and decreased low-density lipoprotein levels (aHR, 0.98; 95% CI, 0.96-1.00) independently predicted incident CVD in the entire cohort, in subjects with obesity, and in those without obesity, respectively. Conclusion: Individuals with overweight or lean NAFLD are not protected from incident CVD compared to those with NAFLD and obesity, although CVD predictors appear to vary between these groups. Patients without obesity also should undergo rigorous risk stratification and treatment.
非酒精性脂肪性肝病（NAFLD）与肥胖和心血管疾病（CVD）独立相关。CVD 是大多数肥胖的 NAFLD 成年患者死亡的主要原因。NAFLD 越来越多地出现在瘦人和超重（即非肥胖）的人群中，但尚不清楚他们患 CVD 的风险是否与肥胖的 NAFLD 患者相当。我们使用 NAFLD 的前瞻性队列研究，比较了肥胖和非肥胖个体中 CVD 的患病率和发生率。通过排除其他慢性肝病病因后，通过活检或影像学诊断为 NAFLD。使用逻辑回归比较了根据肥胖状况基线 CVD 的几率。使用 Cox 比例风险回归评估肥胖作为 CVD 事件的预测因子，并确定肥胖和非肥胖患者 CVD 的预测因子。在基线时，肥胖成年人的 CVD 患病率高于非肥胖者（12.0%比 5.0%，P=0.02）。然而，在随访期间，肥胖并未预测 CVD 事件（危险比 [HR]，1.24；95%置信区间 [CI]，0.69-2.22）或其他代谢疾病。当将体重指数视为连续变量考虑时，以及在排除超重患者后，结果仍然一致。年龄（调整后的 HR [aHR]，1.05；95%CI，1.03-1.08）、吸烟（aHR，4.61；95%CI，1.89-11.22）和降低的低密度脂蛋白水平（aHR，0.98；95%CI，0.96-1.00）分别独立预测了整个队列、肥胖患者和非肥胖患者的 CVD 事件。结论：与肥胖的 NAFLD 患者相比，超重或瘦的 NAFLD 患者并不能预防 CVD 事件的发生，尽管这些患者 CVD 的预测因素可能有所不同。没有肥胖的患者也应该进行严格的风险分层和治疗。
