Anand Abhinav, Singh Amit A, Elhence Anshuman, Vaishnav Manas, Biswas Sagnik, Gunjan Deepak, Gamanagatti Shivanand R, Nayak Baibaswata, Kumar Ramesh
Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India.
Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
J Clin Exp Hepatol. 2022 Mar-Apr;12(2):362-371. doi: 10.1016/j.jceh.2021.07.013. Epub 2021 Jul 31.
Nonalcoholic fatty liver disease (NAFLD) is the commonest cause of chronic liver disease worldwide. Despite the high prevalence, no screening recommendations yet exist. We designed a prospective observational study to estimate the prevalence of NAFLD in the family of patients with NAFLD and develop a predictive model for identifying it.
The prevalence of NAFLD in patients' family members was estimated using ultrasonography, and univariate and multivariate odds were calculated for its predictors. A model was created using the significant parameters on multivariate odds, and its performance was tested using the area under the receiver operating characteristic (AUROC).
Among 447 family members of 191 patients with NAFLD, the prevalence of NAFLD was 55.9%. Family members with NAFLD were younger and had lower serum levels of aspartate aminotransferase, alanine aminotransferase (ALT), triglycerides. The liver stiffness measurement and controlled attenuation parameter values were also lesser in family members compared to the index cases. Age, body mass index (BMI), and ALT were independent predictors of NAFLD in the family members. A model combining age and BMI had an AUROC of 0.838 [95% confidence interval (CI) 0.800-0.876, < 0.001]. Age ≥30 years and BMI ≥25 kg/m had an odds ratio of 33.5 (95% CI 17.0-66.0, < 0.001) for prediction of NAFLD, in comparison to BMI <25 kg/m and age <30 years.
Family members of patients with NAFLD are at increased risk of NAFLD. Screening strategies using BMI and age ensure early identification and could be beneficial in clinical practice.
非酒精性脂肪性肝病（NAFLD）是全球慢性肝病最常见的病因。尽管其患病率很高，但尚无筛查建议。我们设计了一项前瞻性观察性研究，以估计NAFLD患者家庭中NAFLD的患病率，并开发一种识别NAFLD的预测模型。
采用超声检查估计患者家庭成员中NAFLD的患病率，并计算其预测因素的单因素和多因素比值比。使用多因素比值比中的显著参数创建一个模型，并使用受试者操作特征曲线下面积（AUROC）测试其性能。
在191例NAFLD患者的447名家庭成员中，NAFLD的患病率为55.9%。患有NAFLD的家庭成员更年轻，血清天冬氨酸转氨酶、丙氨酸转氨酶（ALT）、甘油三酯水平更低。与索引病例相比，家庭成员的肝脏硬度测量值和受控衰减参数值也更低。年龄、体重指数（BMI）和ALT是家庭成员中NAFLD的独立预测因素。结合年龄和BMI的模型的AUROC为0.838[95%置信区间（CI）0.800 - 0.876，P<0.001]。与BMI<25kg/m且年龄<30岁相比，年龄≥30岁且BMI≥25kg/m预测NAFLD的比值比为33.5（95%CI 17.0 - 66.0，P<0.001）。
NAFLD患者的家庭成员患NAFLD的风险增加。使用BMI和年龄的筛查策略可确保早期识别，在临床实践中可能有益。
