Center of Hypertension, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Sixth Clinical Medical School, Capital Medical University, Beijing, China.
Front Endocrinol (Lausanne). 2024 Feb 9;15:1340644. doi: 10.3389/fendo.2024.1340644. eCollection 2024.
Non-alcoholic fatty liver disease (NAFLD) is increasingly observed in non-obese individuals. The ZJU (Zhejiang University) index has been established as a new and efficient tool for detecting NAFLD, but the relationship between the ZJU index and NAFLD within non-obese individuals still remains unclear.
A evaluation was undertaken using data from a health assessment database by the Wenzhou Medical Center. The participants were divided into four groups based on the quartile of the ZJU Index. Cox proportional hazards regression, Kaplan-Meier analysis and tests for linear trends were used to evaluate the relationship between the ZJU index and NAFLD incidence. Subgroup analysis was conducted to test the consistency of the correlation between ZJU and NAFLD in subsgroups. Receiver operative characteristic (ROC) curve analysis was performed to evaluate the predictive performance of the ZJU index, compared with the Atherogenic index of plasma (AIP) and Remnant lipoprotein cholesterol (RLP-C) index.
A total of 12,127 were included in this study, and 2,147 participants (17.7%) developed NAFLD in 5 years follow-up. Participants in higher ZJU quartiles tended to be female and have higher liver enzymes (including ALP, GGT, ALT, AST), GLU, TC, TG, LDL and higher NAFLD risk. Hazard Ratios (HR) and 95% confidence intervals (CI) for new-onset NAFLD in Q2, Q3, and Q4 were 3.67(2.43 to 5.55), 9.82(6.67 to 14.45), and 21.67(14.82 to 31.69) respectively in the fully adjusted model 3. With increased ZJU index, the cumulative new-onset NAFLD gradually increased. Significant linear associations were observed between the ZJU index and new-onset NAFLD (p for trend all<0.001). In the subgroup analysis, we noted a significant interaction in sex, with HRs of 3.27 (2.81, 3.80) in female and 2.41 (2.21, 2.63) in male (P for interaction<0.01). The ZJU index outperformed other indices with an area under the curve (AUC) of 0.823, followed by AIP (AUC=0.747) and RLP-C (AUC=0.668).
The ZJU index emerges as a promising tool for predicting NAFLD risk in non-obese individuals, outperforming other existing parameters including AIP and RLP-C. This could potentially aid in early detection and intervention in this specific demographic.
非酒精性脂肪性肝病（NAFLD）在非肥胖个体中越来越常见。ZJU 指数已被确立为一种新的、有效的检测 NAFLD 的工具，但 ZJU 指数与非肥胖个体中 NAFLD 之间的关系仍不清楚。
采用温州医科大学健康评估数据库的数据进行评估。参与者根据 ZJU 指数的四分位数分为四组。采用 Cox 比例风险回归、Kaplan-Meier 分析和线性趋势检验评估 ZJU 指数与 NAFLD 发生率之间的关系。进行亚组分析以检验 ZJU 与 NAFLD 在亚组中的相关性是否一致。采用受试者工作特征（ROC）曲线分析评估 ZJU 指数与载脂蛋白致动脉粥样硬化指数（AIP）和残余脂蛋白胆固醇（RLP-C）指数的预测性能。
本研究共纳入 12127 名参与者，5 年随访期间有 2147 名（17.7%）参与者发生 NAFLD。ZJU 四分位数较高的参与者往往为女性，且具有较高的肝酶（包括 ALP、GGT、ALT、AST）、GLU、TC、TG、LDL，且发生 NAFLD 的风险较高。在完全调整模型 3 中，Q2、Q3 和 Q4 中 NAFLD 新发病例的风险比（HR）和 95%置信区间（CI）分别为 3.67（2.43 至 5.55）、9.82（6.67 至 14.45）和 21.67（14.82 至 31.69）。随着 ZJU 指数的增加，新发病例的累积 NAFLD 逐渐增加。ZJU 指数与新发 NAFLD 之间存在显著的线性关联（趋势检验 P<0.001）。在亚组分析中，我们注意到性别存在显著的交互作用，女性的 HR 为 3.27（2.81，3.80），男性为 2.41（2.21，2.63）（P 交互<0.01）。ZJU 指数的曲线下面积（AUC）为 0.823，优于其他指数，包括 AIP（AUC=0.747）和 RLP-C（AUC=0.668）。
ZJU 指数有望成为预测非肥胖个体 NAFLD 风险的一种有前途的工具，优于包括 AIP 和 RLP-C 在内的其他现有参数。这可能有助于在这一特定人群中进行早期检测和干预。
