Xin Zhuojun, Huang Jiaojiao, Cao Qiuyu, Wang Jialu, He Ruixin, Hou Tianzhichao, Ding Yi, Lu Jieli, Wang Tiange, Zhao Zhiyun, Wang Weiqing, Ning Guang, Xu Min, Bi Yufang, Xu Yu, Li Mian
Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai Key Laboratory for Endocrine TumorState Key Laboratory of Medical GenomicsShanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2Nd Road, Shanghai, 200025, China.
Nutr Metab (Lond). 2023 Mar 10;20(1):15. doi: 10.1186/s12986-023-00734-3.
Metabolic dysfunction is a major determinant in the progression of fatty liver disease. It is pivotal to evaluate the metabolic status and subsequent transition in fatty liver population and to identify the risk of subclinical atherosclerosis.
The prospective cohort study included 6260 Chinese community residents during 2010-2015. Fatty liver was determined as hepatic steatosis (HS) by ultrasonography. Metabolic unhealthy (MU) status was defined as having diabetes and/or ≥ 2 metabolic risk factors. Participants were categorized into 4 groups according to the combination of metabolic healthy (MH)/MU and fatty liver status (MHNHS, MUNHS, MHHS and MUHS). Subclinical atherosclerosis was assessed by elevated brachial-ankle pulse wave velocity, pulse pressure and/or albuminuria.
31.3% of the participants had fatty liver disease and 76.9% were in MU status. During a 4.3-year follow-up, 24.2% of participants developed composite subclinical atherosclerosis. Multivariable adjusted odds ratios for composite subclinical atherosclerosis risk were (1.66 [1.30-2.13]) in MUNHS group and (2.57 [1.90-3.48]) in MUHS group. It seemed that participants with fatty liver disease were more prone to be remained in MU status (90.7% vs.50.8%) and less likely to regress to MH status (4.0% vs. 8.9%). Fatty liver participants progressed to (3.11 [1.23-7.92]) or maintained MU status (4.87 [3.25-7.31]) significantly impelled the development of the composite risk, while regressing to MH status (0.15 [0.04-0.64]) were more intended to mitigate the risk.
The current study emphasized the importance of assessing metabolic status and its dynamic changes, especially in the fatty liver population. Regressing from MU to MH status not only benefited the systematic metabolic profile but also ameliorated future cardiometabolic complications.
代谢功能障碍是脂肪肝疾病进展的主要决定因素。评估脂肪肝人群的代谢状态及其后续转变，并识别亚临床动脉粥样硬化风险至关重要。
这项前瞻性队列研究纳入了2010年至2015年期间的6260名中国社区居民。通过超声检查将脂肪肝确定为肝脂肪变性（HS）。代谢不健康（MU）状态定义为患有糖尿病和/或≥2种代谢危险因素。参与者根据代谢健康（MH）/MU和脂肪肝状态的组合分为4组（MHNHS、MUNHS、MHHS和MUHS）。通过肱踝脉搏波速度升高、脉压和/或蛋白尿评估亚临床动脉粥样硬化。
31.3%的参与者患有脂肪肝疾病，76.9%处于MU状态。在4.3年的随访期间，24.2%的参与者出现了复合亚临床动脉粥样硬化。MUNHS组复合亚临床动脉粥样硬化风险的多变量调整优势比为（1.66[1.30-2.13]），MUHS组为（2.57[1.90-3.48]）。似乎患有脂肪肝疾病的参与者更倾向于保持MU状态（90.7%对50.8%），而回归到MH状态的可能性较小（4.0%对8.9%）。进展为（3.11[1.23-7.92]）或维持MU状态（4.87[3.25-7.31]）的脂肪肝参与者显著推动了复合风险的发展，而回归到MH状态（0.15[0.04-0.64]）更倾向于降低风险。
本研究强调了评估代谢状态及其动态变化（尤其是在脂肪肝人群中）的重要性。从MU状态回归到MH状态不仅有益于系统代谢状况，还能改善未来的心脑血管并发症。
