美国成年人的代谢综合征胰岛素抵抗/稳态模型评估胰岛素抵抗与代谢功能障碍相关脂肪性肝病：剂量反应相关性及体力活动介导的影响

METS-IR/HOMA-IR and MAFLD in U.S. adults: dose-response correlation and the effect mediated by physical activity.

作者信息

Peng Hongye, Xiang Jingjing, Pan Liang, Zhao Mo, Chen Bin, Huang Shuxia, Yao Ziang, Liu Jing, Lv Wenliang

机构信息

Department of Infection, Guang'anmen Hospital, , China Academy of Chinese Medical Sciences, Beijing, China.

Graduate School, Beijing University of Chinese Medicine, 100029, Beijing, China.

出版信息

BMC Endocr Disord. 2024 Aug 1;24(1):132. doi: 10.1186/s12902-024-01646-w.

DOI:10.1186/s12902-024-01646-w

PMID:39085855

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11293050/

Abstract

OBJECTIVES

Metabolic dysfunction-associated fatty liver disease (MAFLD), a globally prevalent disease, is closely linked to insulin resistance (IR). Physical activity (PA) is closely linked to both MAFLD and IR. We aim to explore the dose-response relationship between metabolic score for IR (METS-IR)/homeostasis model assessment of IR (HOMA-IR) and MAFLD, and investigate the relationship between PA, IR and MAFLD.

METHODS

Participants from the NHANES study were included in this cross-section study. Logistic regression and the receiver operating characteristic were used to assess the predictive performance of METS-IR/HOMA-IR for MAFLD. Restrictive cubic splines were performed to visualize their dose-response relationship. Decision tree analysis was used to identify high-risk populations of MAFLD. PA's mediating effect in the association between METS-IR/HOMA-IR and MAFLD was also examined.

RESULTS

Of all 1,313 participants, 693 had MAFLD (52.78%). There were a positive association between METS-IR (OR = 1.162, 95% CI = 1.126-1.199) and HOMA-IR (OR = 1.630, 95% CI = 1.431-1.856) and MAFLD risk. The AUCs of the METS-IR and HOMA-IR were 0.831 (0.809, 0.853) and 0.767 (0.741, 0.791), respectively, with significantly different predictive performance (P < 0.001). Adding METS-IR/HOMA-IR to the basic model greatly improved the statistical significance for MAFLD. Five high-risk subgroups were identified for MAFLD. PA mediated about 0.81% and 0.78% (indirect effect/total effect) in the association between METS-IR/HOMA-IR and MAFLD.

CONCLUSIONS

MAFLD risk might be predicted by METS-IR/HOMA-IR, among which METS-IR performed better. And PA mediated the association between them. More attention should be paid to the therapeutic effect of lifestyle changes on MAFLD.

HIGHLIGHTS

Positive associations were found between METS-IR and HOMA-IR and MAFLD risk. 2. METS-IR has better predictive performance for MAFLD risk than HOMA-IR. 3.Two high-risk subgroups were identified for MAFLD by METS-IR: individuals with METS-IR ≥ 40; Hispanic black individuals with 34 ≤ METS-IR < 40 and aged ≥ 46. 4. In the significant association between METS-IR/HOMA-IR and MAFLD, about 0.81% and 0.78% (indirect effect/total effect), respectively, were mediated by physical activity.

摘要

目的

代谢功能障碍相关脂肪性肝病（MAFLD）是一种全球流行的疾病，与胰岛素抵抗（IR）密切相关。体力活动（PA）与MAFLD和IR均密切相关。我们旨在探讨胰岛素抵抗代谢评分（METS-IR）/胰岛素抵抗稳态模型评估（HOMA-IR）与MAFLD之间的剂量反应关系，并研究PA、IR和MAFLD之间的关系。

方法

来自美国国家健康与营养检查调查（NHANES）研究的参与者被纳入本横断面研究。采用逻辑回归和受试者工作特征曲线来评估METS-IR/HOMA-IR对MAFLD的预测性能。进行限制性立方样条分析以可视化它们的剂量反应关系。使用决策树分析来确定MAFLD的高危人群。还检验了PA在METS-IR/HOMA-IR与MAFLD之间关联中的中介作用。

结果

在所有1313名参与者中，693人患有MAFLD（52.78%）。METS-IR（比值比[OR]=1.162，95%置信区间[CI]=1.126-1.199）和HOMA-IR（OR=1.630，95%CI=1.431-1.856）与MAFLD风险呈正相关。METS-IR和HOMA-IR的曲线下面积（AUC）分别为0.831（0.809，0.853）和0.767（0.741，0.791），预测性能有显著差异（P<0.001）。在基本模型中加入METS-IR/HOMA-IR大大提高了对MAFLD的统计学显著性。确定了MAFLD的五个高危亚组。PA在METS-IR/HOMA-IR与MAFLD之间的关联中介导了约0.81%和0.78%（间接效应/总效应）。

结论

METS-IR/HOMA-IR可能预测MAFLD风险，其中METS-IR表现更好。并且PA介导了它们之间的关联。应更多关注生活方式改变对MAFLD的治疗效果。

要点

发现METS-IR和HOMA-IR与MAFLD风险呈正相关。2. METS-IR对MAFLD风险的预测性能优于HOMA-IR。3. 通过METS-IR确定了MAFLD的两个高危亚组：METS-IR≥40的个体；METS-IR为34≤METS-IR<40且年龄≥46岁的西班牙裔黑人个体。4. 在METS-IR/HOMA-IR与MAFLD的显著关联中，体力活动分别介导了约0.81%和0.78%（间接效应/总效应）。