严重肥胖与代谢相关脂肪性肝病（lean metabolic dysfunction-associated steatotic liver disease）患者的预后不良有关。

Severe obesity is associated with worse outcomes than lean metabolic dysfunction-associated steatotic liver disease.

机构信息

Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

出版信息

Hepatol Commun. 2024 Jun 27;8(7). doi: 10.1097/HC9.0000000000000471. eCollection 2024 Jul 1.

DOI:10.1097/HC9.0000000000000471

PMID:38934706

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11213590/

Abstract

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in people with obesity. We aimed to study the association of body mass index (BMI) with clinical outcomes in patients with MASLD.

METHODS

A retrospective cohort of 32,900 patients with MASLD, identified through the International Classification of Diseases-9 and 10 codes within the electronic health records of a large US-based health system, with a mean follow-up of 5.5 years (range: 1-15 y), was stratified into 6 BMI categories, <25, 25-<30, 30-<40, 40-<50, and ≥50 kg/m2.

RESULTS

The risk of liver decompensation and extrahepatic obesity-associated cancers had a J-shaped profile (both ps for linear and quadratic terms <0.05). Compared to patients with BMI 25-<30 kg/m2, the adjusted HRs (95% CIs) for liver decompensation of patients with BMI <25 and BMI ≥50 kg/m2 were 1.44 (1.17-1.77) and 2.27 (1.66-3.00), respectively. The corresponding figures for obesity-associated extrahepatic cancer were 1.15 (0.97-1.36) and 1.29 (1.00-1.76). There was an inverse association for BMI with liver transplantation and non-obesity-associated cancer (both ps for linear terms <0.05), but no association with HCC or all types of cancers combined. A similar J-shaped association between BMI and all-cause mortality was observed; adjusted HRs (95% CIs) for BMI <25 and ≥50 kg/m2 were 1.51 (1.32-1.72) and 3.24 (2.67-3.83), respectively, compared with BMI 25-<30 kg/m2 (both ps for linear and quadratic terms <0.001).

CONCLUSIONS

Patients with MASLD and very severe obesity (BMI ≥50 kg/m2) had the highest risk, exceeding that of patients with lean MASLD, for developing liver decompensation, obesity-associated extrahepatic cancers, or dying from any cause.

摘要

背景

代谢功能障碍相关脂肪性肝病（MASLD）在肥胖人群中高发。本研究旨在探究体质量指数（BMI）与 MASLD 患者临床结局的相关性。

方法

回顾性分析了美国某大型健康系统电子病历中使用国际疾病分类第 9 版和第 10 版编码识别的 32900 例 MASLD 患者，平均随访 5.5 年（1-15 年），并根据 BMI 将患者分为 6 个组别，<25、25-<30、30-<40、40-<50 和≥50kg/m2。

结果

肝失代偿和肝外肥胖相关癌症风险呈“J”型分布（线性和二次项 p 值均<0.05）。与 BMI 25-<30kg/m2 的患者相比，BMI<25kg/m2 和 BMI≥50kg/m2 的患者发生肝失代偿的调整后 HR（95%CI）分别为 1.44（1.17-1.77）和 2.27（1.66-3.00）。相应的肥胖相关肝外癌症的 HR 值分别为 1.15（0.97-1.36）和 1.29（1.00-1.76）。BMI 与肝移植和非肥胖相关癌症呈负相关（线性项 p 值均<0.05），但与 HCC 或所有类型癌症均无相关性。BMI 与全因死亡率也呈“J”型关联；与 BMI 25-<30kg/m2 相比，BMI<25kg/m2 和 BMI≥50kg/m2 的调整后 HR（95%CI）分别为 1.51（1.32-1.72）和 3.24（2.67-3.83）（线性和二次项 p 值均<0.001）。