肝脂肪变性、代谢功能障碍与死亡率风险：一项多国前瞻性队列研究的结果。
Hepatic steatosis, metabolic dysfunction and risk of mortality: findings from a multinational prospective cohort study.
机构信息
Nutrition and Metabolism Branch, International Agency for Research On Cancer (IARC-WHO), 25 Avenue Tony Garnier, Lyon, 69007, France.
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
出版信息
BMC Med. 2024 Jun 3;22(1):221. doi: 10.1186/s12916-024-03366-3.
BACKGROUND
Non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS) are implicated in the aetiology of non-communicable diseases. Our study aimed to evaluate associations between NAFLD and MetS with overall and cause-specific mortality.
METHODS
We used dietary, lifestyle, anthropometric and metabolic biomarker data from a random subsample of 15,784 EPIC cohort participants. NAFLD was assessed using the fatty liver index (FLI) and MetS using the revised definition. Indices for metabolic dysfunction-associated fatty liver disease (MAFLD) were calculated. The individual associations of these indices with overall and cause-specific mortality were assessed using multivariable Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs). As a subobjective, risk associations with adaptations of new classifications of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic and alcohol-related liver disease (MetALD) were also assessed.
RESULTS
Among the 15,784 sub-cohort participants, a total of 1997 deaths occurred (835 due to cancer, 520 to CVD, 642 to other causes) over a median 15.6 (IQR, 12.3-17.1) years of follow-up. Compared to an FLI < 30, FLI ≥ 60 was associated with increased risks of overall mortality (HR = 1.44, 95%CI = 1.27-1.63), and deaths from cancer (HR = 1.32, 95%CI = 1.09-1.60), CVD (HR = 2.06, 95% CI = 1.61-2.63) or other causes (HR = 1.21, 95%CI = 0.97-1.51). Mortality risk associations were also elevated for individuals with MAFLD compared to those without. Individuals with MetS were at increased risk of all mortality endpoints, except cancer-specific mortality. MASLD and MetALD were associated with higher risk of overall mortality.
CONCLUSIONS
Our findings based on a prospective cohort suggest that individuals with hepatic steatosis or metabolic dysfunction have a higher overall and cause-specific mortality risk.
背景
非酒精性脂肪性肝病 (NAFLD) 和代谢综合征 (MetS) 与非传染性疾病的病因有关。我们的研究旨在评估 NAFLD 和 MetS 与全因和特定原因死亡率之间的关联。
方法
我们使用 EPIC 队列的 15784 名随机亚组参与者的饮食、生活方式、人体测量和代谢生物标志物数据。使用脂肪肝指数 (FLI) 评估 NAFLD，使用修订后的定义评估 MetS。计算代谢功能障碍相关脂肪性肝病 (MAFLD) 的指数。使用多变量 Cox 比例风险模型评估这些指数与全因和特定原因死亡率的个体关联，以估计风险比 (HR) 和 95%置信区间 (95%CI)。作为子目标，还评估了新分类的代谢功能障碍相关脂肪性肝病 (MASLD) 和代谢和酒精相关肝病 (MetALD) 的适应风险关联。
结果
在 15784 名亚队列参与者中，在中位随访 15.6 年（IQR，12.3-17.1）期间共发生 1997 例死亡（835 例死于癌症，520 例死于心血管疾病，642 例死于其他原因）。与 FLI<30 相比，FLI≥60 与全因死亡率增加相关（HR=1.44，95%CI=1.27-1.63），与癌症（HR=1.32，95%CI=1.09-1.60）、心血管疾病（HR=2.06，95%CI=1.61-2.63）或其他原因（HR=1.21，95%CI=0.97-1.51）死亡风险增加。与无 MAFLD 个体相比，MAFLD 个体的死亡率风险也更高。患有 MetS 的个体有更高的全因死亡率风险，除了癌症特异性死亡率。MASLD 和 MetALD 与更高的全因死亡率风险相关。
结论
基于前瞻性队列的研究结果表明，有肝脂肪变性或代谢功能障碍的个体全因和特定原因死亡率风险更高。
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