Kim Gi-Ae, Oh Chi Hyuk, Kim Jung Wook, Jeong Su Jin, Oh In-Hwan, Lee Jin San, Park Key-Chung, Shim Jae-Jun
Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, South Korea.
Department of Preventive Medicine, Kyung Hee University School of Medicine, Seoul, South Korea.
Liver Int. 2022 May;42(5):1027-1036. doi: 10.1111/liv.15244. Epub 2022 Mar 23.
Little is known about the association between non-alcoholic fatty liver disease (NAFLD) and dementia. Given that hepatic steatosis is linked to abnormal fat metabolism, and fat dysregulation in the brain is related to dementia, we aimed to investigate whether NAFLD is associated with an increased risk of dementia.
We conducted a nationwide cohort study involving 4 031 948 subjects aged 40-69 years who underwent ≥2 health check-ups provided by the National Health Insurance Service in Korea between January 2004 and December 2007. Based on the hepatic steatosis index (HSI), subjects were categorized into non-NAFLD (HSI <30 at all check-ups) and NAFLD (HSI >36 at one or more check-ups). Dementia defined by ICD-10 codes with prescription data was followed up until December 2017. Cox proportional hazards regression models analysed the dementia risk.
At baseline, 31.3% had NAFLD. During the median follow-up of 9.5 years, 138 424 in NAFLD group and 69 982 in non-NAFLD group developed dementia. NAFLD group was associated with a higher risk of dementia than non-NAFLD group on multivariable-adjusted analysis (hazard ratio [HR], 1.05; p < .001), competing risk analysis (HR, 1.08; p < .001) and propensity-score matched analysis (HR, 1.09; p < .001). The association between NAFLD and dementia risk was more prominent among females (HR, 1.16; p < .001). The association was stronger among non-obese NAFLD subjects (BMI <25 kg/m , HR, 1.09; p < .001) than obese NAFLD subjects.
This nationwide study found that NAFLD is associated with an increased risk of dementia. The association was prominent among females and non-obese NAFLD subjects.
关于非酒精性脂肪性肝病（NAFLD）与痴呆之间的关联，人们了解甚少。鉴于肝脂肪变性与异常脂肪代谢有关，且大脑中的脂肪调节异常与痴呆相关，我们旨在研究NAFLD是否与痴呆风险增加有关。
我们进行了一项全国性队列研究，纳入了4031948名年龄在40 - 69岁之间的受试者，他们在2004年1月至2007年12月期间接受了韩国国民健康保险服务提供的≥2次健康检查。根据肝脂肪变性指数（HSI），将受试者分为非NAFLD组（所有检查时HSI <30）和NAFLD组（一次或多次检查时HSI >36）。通过ICD - 10编码及处方数据定义的痴呆进行随访，直至2017年12月。采用Cox比例风险回归模型分析痴呆风险。
在基线时，31.3%的人患有NAFLD。在中位随访9.5年期间，NAFLD组有138424人发生痴呆，非NAFLD组有69982人发生痴呆。多变量调整分析显示，NAFLD组患痴呆的风险高于非NAFLD组（风险比[HR]为1.05；p <.001），竞争风险分析（HR为1.08；p <.001）和倾向得分匹配分析（HR为1.09；p <.001）。NAFLD与痴呆风险之间的关联在女性中更为显著（HR为1.16；p <.001）。非肥胖NAFLD受试者（BMI <25 kg/m²，HR为1.09；p <.001）中的关联比肥胖NAFLD受试者更强。
这项全国性研究发现，NAFLD与痴呆风险增加有关。这种关联在女性和非肥胖NAFLD受试者中尤为显著。
