Department of internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, lower Austria, Austria.
First Department of Medicine, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria.
Eur J Intern Med. 2023 Dec;118:98-107. doi: 10.1016/j.ejim.2023.07.039. Epub 2023 Aug 3.
Individuals with lower levels of education are at a higher risk of developing various health conditions due to limited access to healthcare and unhealthy lifestyle choices. However, the association between non-alcoholic fatty liver disease (NAFLD) and educational level remains unclear. Therefore, the aim of this study was to investigate whether there is an independent relationship between NAFLD and educational level as a surrogate marker for socioeconomic status (SES).
This cross-sectional study included 8,727 participants from the Paracelsus 10,000 study. The association between NAFLD and educational level was assessed using multivariable logistic regression models and multivariable linear regression. The primary endpoints were NAFLD (FLI score > 60) and liver fibrosis (FIB-4 score > 1.29). Further subgroup analysis with liver stiffness measurement was done.
In the study, NAFLD prevalence was 23% among participants with high education, 33% among intermediate, and 40% among those with low education (p<0.01). Importantly, a significantly reduced risk of NAFLD was observed in individuals with higher education, as indicated by an adjusted relative risk of 0.52 (p < 0.01). Furthermore, higher education level was associated with significantly lower odds of NAFLD and fibrosis. Additionally, a subgroup analysis revealed that higher liver stiffness measurements were independently associated with lower levels of education.
The study's findings indicate that a lower education level increases the risk of NAFLD independent of confounding factors. Therefore, these findings highlight the potential impact of educational attainment on NAFLD risk and emphasize the need for targeted interventions in vulnerable populations.
由于获得医疗保健的机会有限以及不健康的生活方式选择，受教育程度较低的个体更容易出现各种健康问题。然而，非酒精性脂肪性肝病（NAFLD）与教育程度之间的关联尚不清楚。因此，本研究旨在调查 NAFLD 是否与教育程度存在独立关系，教育程度可作为社会经济地位（SES）的替代标志物。
这项横断面研究纳入了来自 Paracelsus 10000 研究的 8727 名参与者。使用多变量逻辑回归模型和多变量线性回归评估 NAFLD 与教育程度之间的关系。主要终点是 NAFLD（FLI 评分>60）和肝纤维化（FIB-4 评分>1.29）。进一步进行了基于肝硬度测量的亚组分析。
在该研究中，高学历者中 NAFLD 的患病率为 23%，中等学历者为 33%，低学历者为 40%（p<0.01）。重要的是，较高的教育程度与 NAFLD 风险显著降低相关，调整后的相对风险为 0.52（p<0.01）。此外，较高的教育程度与较低的 NAFLD 和纤维化几率相关。此外，亚组分析表明，较高的肝硬度测量值与较低的教育程度独立相关。
该研究结果表明，较低的教育程度独立于混杂因素增加了 NAFLD 的风险。因此，这些发现强调了教育程度对 NAFLD 风险的潜在影响，并强调需要在弱势群体中进行有针对性的干预。
