Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Gangnam Severance Hospital, Yonsei University College of Medicine, Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.
Ann Acad Med Singap. 2023 Nov 29;52(11):570-579. doi: 10.47102/annals-acadmedsg.202379.
Non-alcoholic fatty liver disease (NAFLD) is known to be associated with metabolic syndrome of which diabetes is an important component. Although diabetes is a known risk factor for dementia, studies on the association between NAFLD and dementia still produce conflicting results. This study aimed to determine whether NAFLD would be a risk factor for the development of dementia in an elderly population.
This study included 107,369 subjects aged ≥60 years in the Korean National Health Insurance Service-Senior cohort, entered in 2009 and followed up until 2015. NAFLD was diagnosed by calculating fatty liver index (FLI). Subjects were screened for dementia at baseline using a Korean Dementia Screening Questionnaire, and dementia was diagnosed using ICD-10 codes. Controls were randomly selected at a ratio of 1:5 from individuals who were at risk of becoming the case subjects at the time of selection.
From 107,369 subjects, 65,690 stroke- and dementia-free subjects without chronic hepatitis B or C or excessive alcohol drinking were selected for evaluation. Having NAFLD, determined by FLI, was associated with increased risk of dementia development (adjusted odds ratio [AOR] 1.493; 95% confidence interval [CI] 1.214-1.836). The increased risk of dementia in NAFLD subjects was independent of type 2 diabetes (AOR 1.421; 95% CI 1.013-1.994, in subjects with diabetes: AOR 1.540; 95% CI 1.179- 2.010, in subjects without diabetes).
In this population-based nested case-control study, having NAFLD increased the risk of dementia in elderly individuals, independent of accompanying diabetes.
非酒精性脂肪性肝病（NAFLD）已知与代谢综合征相关，其中糖尿病是一个重要组成部分。虽然糖尿病是痴呆的已知危险因素，但 NAFLD 与痴呆之间的关联研究仍得出相互矛盾的结果。本研究旨在确定非酒精性脂肪性肝病是否是老年人群发生痴呆的危险因素。
本研究纳入了 2009 年参加韩国国家健康保险服务-老年人队列的 107369 名年龄≥60 岁的受试者，并随访至 2015 年。通过计算脂肪性肝病指数（FLI）来诊断 NAFLD。在基线时，使用韩国痴呆症筛查问卷对受试者进行痴呆筛查，并使用 ICD-10 编码诊断痴呆。对照者是在选择时被选为病例受试者的个体中按照 1:5 的比例随机选择的。
从 107369 名受试者中，选择了 65690 名无卒中且无痴呆、无慢性乙型肝炎或丙型肝炎或过量饮酒的受试者进行评估。通过 FLI 确定的 NAFLD 与痴呆发展风险增加相关（调整后的优势比 [AOR] 1.493；95%置信区间 [CI] 1.214-1.836）。NAFLD 患者的痴呆风险增加与 2 型糖尿病无关（在有糖尿病的患者中 AOR 为 1.421；95%CI 为 1.013-1.994，在无糖尿病的患者中 AOR 为 1.540；95%CI 为 1.179-2.010）。
在这项基于人群的巢式病例对照研究中，NAFLD 的存在增加了老年人群发生痴呆的风险，与伴随的糖尿病无关。
