Jafari Elham, Merat Shahin, Anoushiravani Amir, Radmard Amir Reza, Roshandel Gholamreza, Sharafkhah Maryam, Khoshnia Masoud, Nateghi Alireza, Shiravi Khuzani Abolfazl, Poustchi Hossein, Malekzadeh Reza
Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Middle East J Dig Dis. 2024 Apr;16(2):86-95. doi: 10.34172/mejdd.2024.374. Epub 2024 Apr 30.
Metabolic dysfunction-associated fatty liver disease (MAFLD) is a rising global public health concern. It has been demonstrated that its prevalence and characteristics vary by region and racial/ethnicity. We aimed to investigate the prevalence of MAFLD and its characteristics among Turkmen and non-Turkmen ethnic groups in a multiethnic population region of Iran.
In this cross-sectional study, we analyzed baseline data for 1614 participants, aged above 50 years, from the PolyIran-Liver trial who were randomly selected from Gonabad city and determined the prevalence of MAFLD and its demographic and metabolic disorders for both the Turkmen and non-Turkmen ethnic groups. Multivariate binary logistic regressions were applied to identify MAFLD-associated factors for men and women separately for the Turkmen and non-Turkmen populations.
The mean (SD) age of the participants was 59.1(6.7) years. Of the participants, 51.5% (n=831) were men, and 52.9% (n=854) were Turkmen. The prevalence of MAFLD among the overall study population was 39.8% (n=614). It was more common among women (45.8% vs. 34.1% in men, <0.001), non-Turkmens (43.9% vs. 36.1% in Turkmens, <0.001), and at age 50-64 (41.5% vs.36.1% in age≥65 =0.004). The fully adjusted multivariate analysis in sex strata exhibited an independent negative association between Turkmen ethnicity only among men but not among women. The increased waist circumference (WC) was the most common metabolic disorder, observed in more than 95.5% of patients with MAFLD (<0.001). Multivariate analysis in sex/ethnic strata with adjustment for potential confounders revealed an independent association of MAFLD with increased WC, insulin resistance, impaired fasting glucose/diabetes type 2, and high alanine aminotransferase (ALT) among women in both ethnic groups while with elevated triglyceride (TG) only among Turkmen and high body mass index (BMI) only among non-Turkmen women. Increased WC had the strongest independent association with MAFLD among women and the highest odds ratio (OR) with MAFLD in Turkmen women (OR: 6.10; 95% CI 1.56-23.86 vs. 4.80 in non-Turkmen women). Among men, MAFLD was independently associated with insulin resistance, high BMI, and high ALT in both ethnic groups and elevated TG only in non-Turkmen men (all <0.001). Insulin resistance had the strongest independent OR with MAFLD among men with similar size in both ethnic groups (4.68 [95% CI 2.56-8.55]) in non-Turkmen men and 4.37 (95% CI 2.27-8.42 in Turkmen men).
This study revealed the high prevalence of MAFLD with a sex and ethnic disparity in the middle-aged population of Gonabad city. Further research is needed to understand the factors contributing to the higher prevalence of MAFLD in this region, particularly in women. Furthermore, considering the diverse ethnic population of Iran, it is suggested that future investigations on the sex and ethnic aspects of MAFLD in the Iranian population be conducted to provide targeted prevention strategies better suited for the Iranian population.
代谢功能障碍相关脂肪性肝病（MAFLD）是一个日益引起全球公共卫生关注的问题。已经证明，其患病率和特征因地区以及种族/民族而异。我们旨在调查伊朗一个多民族人口地区土库曼族和非土库曼族人群中MAFLD的患病率及其特征。
在这项横断面研究中，我们分析了来自伊朗肝脏多中心试验（PolyIran-Liver trial）的1614名年龄在50岁以上参与者的基线数据，这些参与者是从戈纳巴德市随机选取的，我们确定了土库曼族和非土库曼族人群中MAFLD的患病率及其人口统计学和代谢紊乱情况。应用多变量二元逻辑回归分别确定土库曼族和非土库曼族男性和女性中与MAFLD相关的因素。
参与者的平均（标准差）年龄为59.1（6.7）岁。参与者中，51.5%（n = 831）为男性，52.9%（n = 854）为土库曼族。整个研究人群中MAFLD的患病率为39.8%（n = 614）。在女性中更常见（女性为45.8%，男性为34.1%，P<0.001），在非土库曼族中更常见（非土库曼族为43.9%，土库曼族为36.1%，P<0.001），在50 - 64岁年龄段更常见（50 - 64岁为41.5%，≥65岁为36.1%，P = 0.004）。按性别分层的完全调整多变量分析显示，仅在男性中土库曼族与MAFLD之间存在独立的负相关，而在女性中不存在。腰围（WC）增加是最常见的代谢紊乱，在超过95.5%的MAFLD患者中观察到（P<0.001）。在按性别/种族分层并对潜在混杂因素进行调整的多变量分析中，在两个民族的女性中，MAFLD与WC增加、胰岛素抵抗、空腹血糖受损/2型糖尿病以及高丙氨酸氨基转移酶（ALT）独立相关，而在土库曼族中仅与甘油三酯（TG）升高相关，在非土库曼族女性中仅与高体重指数（BMI）相关。WC增加在女性中与MAFLD的独立关联最强，在土库曼族女性中与MAFLD的比值比（OR）最高（OR：6.10；95%CI 1.56 - 23.86，非土库曼族女性为4.80）。在男性中，两个民族的MAFLD均与胰岛素抵抗、高BMI和高ALT独立相关，仅在非土库曼族男性中与TG升高相关（均P<0.001）。在两个民族中体型相似的男性中，胰岛素抵抗与MAFLD的独立OR最强（非土库曼族男性为4.68 [95%CI 2.56 - 8.55]），土库曼族男性为4.37（95%CI 2.27 - 8.42）。
本研究揭示了戈纳巴德市中年人群中MAFLD的高患病率以及性别和种族差异。需要进一步研究以了解该地区MAFLD患病率较高的因素，特别是在女性中。此外，考虑到伊朗的多民族人口，建议未来对伊朗人群中MAFLD的性别和种族方面进行调查，以提供更适合伊朗人群的针对性预防策略。
