Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland.
Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520 Turku, Finland.
J Clin Endocrinol Metab. 2023 Dec 21;109(1):e291-e305. doi: 10.1210/clinem/dgad418.
The incidence and remission of nonalcoholic fatty liver disease (NAFLD) are sparsely studied outside Asia.
This prospective study aimed to investigate NAFLD incidence and remission, and their predictors among a general Finnish population.
The applied cohort included 1260 repeatedly studied middle-aged participants with data on liver ultrasound and no excessive alcohol intake. Hepatic steatosis was assessed by liver ultrasound with a 7.2-year study interval. Comprehensive data on health parameters and lifestyle factors were available.
At baseline, 1079 participants did not have NAFLD, and during the study period 198 of them developed NAFLD. Of the 181 participants with NAFLD at baseline, 40 achieved NAFLD remission. Taking multicollinearity into account, key predictors for incident NAFLD were baseline age (odds ratio 1.07; 95% CI, 1.02-1.13; P = .009), waist circumference (WC) (2.77, 1.91-4.01 per 1 SD; P < .001), and triglycerides (2.31, 1.53-3.51 per 1 SD; P < .001) and alanine aminotransferase (ALAT) (1.90, 1.20-3.00 per 1 SD; P = .006) concentrations as well as body mass index (BMI) change (4.12, 3.02-5.63 per 1 SD; P < .001). Predictors of NAFLD remission were baseline aspartate aminotransferase (ASAT) concentration (0.23, 0.08-0.67 per 1 SD; P = .007) and WC change (0.38, 0.25-0.59 per 1 SD; P < .001).
During follow-up, NAFLD developed for every fifth participant without NAFLD at baseline, and one-fifth of those with NAFLD at baseline had achieved NAFLD remission. NAFLD became more prevalent during the follow-up period. From a clinical perspective, key factors predicting NAFLD incidence and remission were BMI and WC change independent of their baseline level.
非酒精性脂肪性肝病（NAFLD）的发病率和缓解率在亚洲以外的地区研究甚少。
本前瞻性研究旨在调查普通芬兰人群中 NAFLD 的发病率、缓解率及其预测因素。
应用队列纳入了 1260 名反复进行肝脏超声检查且无过量饮酒史的中年参与者。采用肝脏超声评估肝脂肪变性，研究间隔为 7.2 年。可获得全面的健康参数和生活方式因素数据。
基线时，1079 名参与者无 NAFLD，研究期间 198 名发展为 NAFLD。基线时有 181 名 NAFLD 患者，其中 40 名患者实现了 NAFLD 缓解。考虑到多重共线性，新发 NAFLD 的主要预测因素为基线年龄（比值比 1.07；95%置信区间，1.02-1.13；P =.009）、腰围（WC）（每增加 1 SD，2.77、1.91-4.01；P <.001）和三酰甘油（2.31、1.53-3.51；P <.001）以及丙氨酸氨基转移酶（ALAT）浓度（每增加 1 SD，1.90、1.20-3.00；P =.006）以及体重指数（BMI）变化（每增加 1 SD，4.12、3.02-5.63；P <.001）。NAFLD 缓解的预测因素为基线天冬氨酸氨基转移酶（ASAT）浓度（0.23、0.08-0.67；P =.007）和 WC 变化（0.38、0.25-0.59；P <.001）。
在随访期间，每 5 名基线时无 NAFLD 的参与者中就有 1 名发展为 NAFLD，而基线时有 1/5 的 NAFLD 患者实现了 NAFLD 缓解。NAFLD 在随访期间变得更为普遍。从临床角度来看，预测 NAFLD 发病和缓解的关键因素是 BMI 和 WC 的变化，且与基线水平无关。
