Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Maastricht University Medical Center, Maastricht, the Netherlands; Laboratory for Metabolism and Vascular Medicine, Maastricht University, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology, Maastricht University, Maastricht, the Netherlands.
Dig Liver Dis. 2024 Apr;56(4):565-570. doi: 10.1016/j.dld.2023.11.040. Epub 2023 Dec 15.
Observational studies have identified an inverse association between education and non-alcoholic fatty liver disease (NAFLD). However, it is not possible to establish causality for this relationship.
To gain more insight into the causal nature of the relationship between education and NAFLD.
We performed two-sample Mendelian randomization (MR) analyses using summary-level, large-scale datasets to study the association of genetically predicted educational attainment (n = 1271 genetic instruments, obtained from 1,131,881 participants) with risk of NAFLD (i.e., liver fat [n = 32,858 participants] and electronic health record (EHR)-based NAFLD [n = 778,614 participants]). In sensitivity analyses, educational attainment was replaced by three education-related traits (i.e., genetically predicted cognition, math ability and highest math).
Inverse-variance weighted method showed a statistically significant association between genetically predicted educational attainment and liver fat (beta: -0.251, 95%CI: -0.305; -0.198) and EHR-based NAFLD (OR: 0.609, 95%CI: 0.547; 0.677). MR-Egger regression did not show statistically significant intercepts. Similar findings were obtained when other MR tests were used or when educational attainment was replaced by education-related traits.
This study suggests a causal, protective effect of higher education on NAFLD risk. Societal interventions targeted at people with low education are needed to alleviate the burden of NAFLD.
观察性研究已经确定了教育程度与非酒精性脂肪肝（NAFLD）之间呈负相关关系。然而，对于这种关系，我们无法确定其因果关系。
深入了解教育程度与 NAFLD 之间的因果关系。
我们使用两样本 Mendelian 随机化（MR）分析，使用汇总水平的大规模数据集，研究遗传预测的教育程度（n = 1271 个遗传工具，来自 1131881 名参与者）与 NAFLD 风险之间的关联（即肝脂肪[n = 32858 名参与者]和电子健康记录（EHR）基于的 NAFLD [n = 778614 名参与者]）。在敏感性分析中，教育程度被三种与教育相关的特征（即遗传预测的认知、数学能力和最高数学）所取代。
逆方差加权法显示，遗传预测的教育程度与肝脂肪（β：-0.251，95%CI：-0.305；-0.198）和 EHR 基于的 NAFLD（OR：0.609，95%CI：0.547；0.677）之间存在统计学上显著的关联。MR-Egger 回归未显示出统计学上显著的截距。当使用其他 MR 检验或用教育相关特征替代教育程度时，也得到了类似的发现。
这项研究表明，较高的教育程度对 NAFLD 风险有因果保护作用。需要针对受教育程度较低的人群采取社会干预措施，以减轻 NAFLD 的负担。
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