甘油三酯介导了体重指数对正常低密度脂蛋白胆固醇水平的非肥胖中国人群中非酒精性脂肪性肝病的影响。

Triglycerides Mediate the Influence of Body Mass Index on Non-Alcoholic Fatty Liver Disease in a Non-Obese Chinese Population with Normal Low-Density Lipoprotein Cholesterol Levels.

机构信息

Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China,

College of Integrated Traditional Chinese and Westem Medicine, Jining Medical University, Jining, China,

出版信息

Obes Facts. 2024;17(2):191-200. doi: 10.1159/000536447. Epub 2024 Jan 24.

DOI:10.1159/000536447

PMID:38266508

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10987190/

Abstract

INTRODUCTION

Over 25% of the world's population has non-obese or lean non-alcoholic fatty liver disease (NAFLD), and the prevalence is higher than average in Asia. The present study focused on the relationship between body mass index (BMI) and non-obese NAFLD in non-overweight people in China, particularly the influence of triglycerides (TG) in the pathogenesis of non-obese NAFLD. The findings suggest new treatments for NAFLD patients with normal BMI, as well as provide an early warning system for the understanding and prevention of NAFLD in non-obese patients.

METHODS

This cross-sectional study enrolled 159,959 Chinese subjects with BMI <24 kg/m2 and normal levels of low-density lipoprotein cholesterol (LDL-c). The average age was 40.21 ± 13.88 years, and males accounted for 45.7%. A total of 15,907 (9.94%) patients with NAFLD were diagnosed by ultrasonography. Biochemical indicators were measured using an automated analyzer (Abbott AxSYM). The BMI (kg/m2) was calculated from the weight (kg)/height in square meters (m2). The BMI quartile was used as the column-stratified variable to determine the baseline distribution, and logistic regression analysis was used to assess the relationship between NAFLD and its risk factors, with multiple logistic regression used to assess the relationships between BMI or TG and NAFLD and multivariate linear regression used to analyze the association between BMI and TG, while mediation analysis was used to assess the mediation effect of TG.

RESULTS

After adjustment of all covariates, the odds ratios were 1.788 (95% CI: 1.749-1.829; p < 0.00001) and 1.491 (95% CI: 1.451-1.532; p < 0.00001) for the association between BMI and TG with NAFLD incidence. The multivariate linear regression coefficient of BMI and TG was β = 0.027 (95% CI: 0.023-0.030; p < 0.00001). Mediation analysis showed that BMI contributed to 10.81% of lean NAFLD with a mediation effect of 2.98%.

CONCLUSION

In a Chinese population with BMI <24 kg/m2 and normal LDL-c levels, BMI and TG were found to be independent predictors of NAFLD. The direct effect of BMI on non-obese NAFLD was 10.41%. The TG level was found to partially mediate the association.

摘要

简介

全球超过 25%的人口患有非肥胖或非酒精性脂肪性肝病（NAFLD），且亚洲的患病率高于平均水平。本研究重点关注中国非超重人群中非肥胖性 NAFLD 与体重指数（BMI）之间的关系，特别是甘油三酯（TG）在非肥胖性 NAFLD 发病机制中的作用。研究结果为 BMI 正常的 NAFLD 患者提供了新的治疗方法，并为非肥胖患者 NAFLD 的理解和预防提供了早期预警系统。

方法

本横断面研究纳入了 159959 名 BMI＜24kg/m2 且低密度脂蛋白胆固醇（LDL-c）水平正常的中国受试者。平均年龄为 40.21±13.88 岁，男性占 45.7%。通过超声诊断出 15907 例（9.94%）NAFLD 患者。使用自动分析仪（雅培 AxSYM）测量生化指标。BMI（kg/m2）由体重（kg）/身高（m2）计算得出。BMI 四分位数作为列分层变量，以确定基线分布，采用 logistic 回归分析评估 NAFLD 及其危险因素之间的关系，采用多元 logistic 回归分析评估 BMI 或 TG 与 NAFLD 的关系，采用多元线性回归分析 BMI 与 TG 之间的关系，采用中介分析评估 TG 的中介效应。

结果

在调整所有协变量后，BMI 和 TG 与 NAFLD 发生率的比值比分别为 1.788（95%CI：1.749-1.829；p＜0.00001）和 1.491（95%CI：1.451-1.532；p＜0.00001）。BMI 和 TG 的多元线性回归系数为β=0.027（95%CI：0.023-0.030；p＜0.00001）。中介分析表明，BMI 导致瘦型 NAFLD 的贡献率为 10.81%，中介效应为 2.98%。