Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Faculty of Health, University of Canberra, Australia.
First Cardiology Clinic, School of Medicine, University of Athens, Greece, Greece.
Metabolism. 2022 Mar;128:154893. doi: 10.1016/j.metabol.2021.154893. Epub 2021 Sep 30.
BACKGROUND/OBJECTIVES: We evaluated the role of the presence of non-alcoholic fatty liver disease (NAFLD) at baseline in the transition from metabolically healthy to metabolically unhealthy obesity (MHO to MUO) ten years later.
A prospective cohort study (ATTICA study, Greece) was performed between 2002 and 2012 studying a sample from the greater metropolitan Athens area. In total, 1514 (49·8%) men and 1528 (50.2%) women (aged >18 years old) free-of-CVD were included. Healthy metabolic status was defined as absence of all NCEP ATP III (2005) metabolic syndrome components. NAFLD was defined according to validated liver steatosis indices. Follow-up CVD assessment (2011-2012) was achieved in n = 2020 participants (n = 317 cases).
NAFLD prevalence among MHO participants ranged from 29% to 39% according to the specific NAFLD score used. MHO participants who developed metabolically unhealthy status had about two times higher odds to have NAFLD at baseline compared with their metabolically healthy normal weight counterparts whereas stable MHO was not associated significantly with NAFLD. Moreover, MHO status accompanied by NAFLD was associated with increased CVD risk (Hazard Ratio = 2.90 95% Confidence Interval (1.35, 5.40)) in comparison to their non-NAFLD MHO counterparts. Further analysis revealed that in the obese, NAFLD indices and not simply visceral adiposity increased significantly the ability of metabolic status (using standard definition) to predict long-term CVD incidence.
Considering NAFLD, even when assessed using validated indices only, in the clinical assessment of apparently healthy obese individuals predicts who is to develop MUO and contributes independently and more accurately to defining future cardiometabolic risk.
背景/目的：我们评估了基线时非酒精性脂肪性肝病（NAFLD）的存在在 10 年后从代谢健康肥胖（MHO）向代谢不健康肥胖（MUO）转变中的作用。
这是一项在 2002 年至 2012 年期间进行的前瞻性队列研究（希腊 ATTICA 研究），研究对象来自大雅典大都市区。共有 1514 名（49.8%）男性和 1528 名（50.2%）女性（年龄大于 18 岁）无心血管疾病（CVD）。健康代谢状态定义为无 NCEP ATP III（2005）代谢综合征所有成分。NAFLD 根据经过验证的肝脂肪变性指数来定义。在 n=2020 名参与者（n=317 例）中进行了随访 CVD 评估（2011-2012 年）。
根据使用的特定 NAFLD 评分，MHO 参与者中 NAFLD 的患病率在 29%至 39%之间。与代谢健康的正常体重对照组相比，发生代谢不健康状态的 MHO 参与者在基线时发生 NAFLD 的可能性约高两倍，而稳定的 MHO 与 NAFLD 无显著相关性。此外，与非 NAFLD MHO 对照组相比，MHO 状态伴 NAFLD 与 CVD 风险增加相关（危险比=2.90，95%置信区间[1.35,5.40]）。进一步分析显示，在肥胖者中，NAFLD 指数而不仅仅是内脏脂肪增加了代谢状态（使用标准定义）预测长期 CVD 发生率的能力。
即使仅使用经过验证的指数评估 NAFLD，在对明显健康的肥胖个体进行临床评估时，也可预测谁将发展为 MUO，并独立且更准确地有助于定义未来的心血管代谢风险。
