Nagai Kei, Harada Takuya, Mase Kaori, Iseki Kunitoshi, Moriyama Toshiki, Tsuruya Kazuhiko, Fujimoto Shouichi, Narita Ichiei, Konta Tsuneo, Kondo Masahide, Kasahara Masato, Shibagaki Yugo, Asahi Koichi, Watanabe Tsuyoshi, Yamagata Kunihiro
Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
The Japan Specific Health Checkups study (J-SHC study) Group, Fukushima, Japan.
JMA J. 2023 Jul 14;6(3):312-320. doi: 10.31662/jmaj.2023-0008. Epub 2023 Jun 30.
Obesity and inappropriate lifestyle is the major risk factors for liver dysfunction and proteinuria. Nevertheless, previous studies have not described the differential impacts of body weight changes and lifestyle modification on already developed liver dysfunction and proteinuria.
The original cohort was 933,490 individuals from the Japanese general population. In this investigation, we included 36,256 obese individuals with elevated levels of aspartate aminotransferase and/or alanine aminotransferase (≥31 IU/L) or positive proteinuria (+/- or more) in both the first and second years. Outcomes were the first normalization of these data defined as improvement in liver dysfunction and proteinuria. Times to outcomes were assessed using the Cox proportional hazards modeling for -1 kg/m/year change in body mass index (BMI) changes in exercise and alcohol intake.
The multivariable-adjusted hazard ratio (HR) for incident improvement in liver dysfunction with BMI change -1.0 kg/m/year was 1.07 (95% confidence interval [CI] 1.05-1.09) in obesity and that with improved proteinuria was 1.04 (95%CI 1.02-1.07). Compared to subjects without exercise habits, subjects who gained exercise habits exhibited a higher rate of improvement in liver dysfunction (HR 1.08; 95%CI 1.01-1.15) but not in proteinuria (HR 0.98; 95%CI 0.88-1.08). Compared to subjects with continuous alcohol intake habits, subjects who quit alcohol intake also showed a higher rate of improvement in liver dysfunction (HR 1.20; 95%CI 1.09-1.32).
This study suggested that weight loss greater than 1 kg/m/year improves liver dysfunction and dipstick proteinuria in obesity. Particularly, liver dysfunction can be remedied by acquiring an exercise habit and quitting alcohol intake.
肥胖和不良生活方式是肝功能障碍和蛋白尿的主要危险因素。然而，先前的研究尚未描述体重变化和生活方式改变对已发生的肝功能障碍和蛋白尿的不同影响。
原始队列包括933490名日本普通人群。在本次调查中，我们纳入了36256名肥胖个体，他们在第一年和第二年的天冬氨酸转氨酶和/或丙氨酸转氨酶水平均升高（≥31 IU/L）或蛋白尿呈阳性（+/-或更高）。结局是这些数据首次恢复正常，定义为肝功能障碍和蛋白尿得到改善。使用Cox比例风险模型评估体重指数（BMI）变化为-1 kg/m/年、运动和饮酒量变化时达到结局的时间。
在肥胖人群中，BMI变化为-1.0 kg/m/年时，肝功能障碍发生率改善的多变量调整风险比（HR）为1.07（95%置信区间[CI] 1.05-1.09），蛋白尿改善的HR为1.04（95%CI 1.02-1.07）。与没有运动习惯的受试者相比，养成运动习惯的受试者肝功能障碍改善率更高（HR 1.08；95%CI 1.01-1.15），但蛋白尿改善率无差异（HR 0.98；95%CI 0.88-1.08）。与持续有饮酒习惯的受试者相比，戒酒的受试者肝功能障碍改善率也更高（HR 1.20；95%CI 1.09-1.32）。
本研究表明，肥胖人群中每年体重减轻超过1 kg/m可改善肝功能障碍和试纸法蛋白尿。特别是，养成运动习惯和戒酒可改善肝功能障碍。
