中心性肥胖是非酒精性脂肪性肝病瘦患者发生高级纤维化的独立决定因素。
Central Obesity is an Independent Determinant of Advanced Fibrosis in Lean Patients With Nonalcoholic Fatty Liver Disease.
作者信息
De Arka, Bhagat Naveen, Mehta Manu, Singh Priya, Rathi Sahaj, Verma Nipun, Taneja Sunil, Premkumar Madhumita, Duseja Ajay
机构信息
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
出版信息
J Clin Exp Hepatol. 2025 Jan-Feb;15(1):102400. doi: 10.1016/j.jceh.2024.102400. Epub 2024 Aug 10.
BACKGROUND
The current definition of lean is based on body mass index (BMI). However, BMI is an imperfect surrogate for adiposity and provides no information on central obesity (CO). Hence, we explored the differences in clinical profile and liver disease severity in lean patients with nonalcoholic fatty liver disease (NAFLD) with and without CO.
METHODS
One hundred seventy lean patients with NAFLD (BMI <23 kg/m) were divided into two groups depending upon the presence or absence of CO (waist circumference ≥80 cm in females and ≥90 cm in males). Noninvasive assessment of steatosis was done by ultrasound and controlled attenuation parameter (CAP), while fibrosis was assessed with FIB-4 and liver stiffness measurement (LSM). FibroScan-AST (FAST) score was used for non-invasive prediction of NASH with significant fibrosis.
RESULTS
Of 170 patients with lean NAFLD, 96 (56.5%) had CO. Female gender (40.6% vs. 17.6%, = 0.001), hypertriglyceridemia (58.3% vs. 39.2%, = 0.01) and metabolic syndrome (23.9% vs. 4.1%, < 0.001) were more common in the CO group. There was a poor correlation between BMI and waist circumference (r = 0.24, 95% CI: 0.09-0.38). Grade 2-3 steatosis on ultrasound was significantly more common in CO patients (30% vs. 12.3%, = 0.007). CAP [312.5 (289.8-341) dB/m vs. 275 (248-305.1) dB/m, = 0.002], FAST score [0.42 (0.15-0.66) vs. 0.26 (0.11-0.39), = 0.04], FIB-4 and LSM were higher in those with CO. Advanced fibrosis was more prevalent among CO patients using FIB-4 (19.8% vs 8.1%, = 0.03) and LSM (9.5% vs. 0, = 0.04). CO was independently associated with advanced fibrosis after adjusting for BMI and metabolic risk factors (aOR: 3.11 (1.10-8.96), = 0.03). Among these 170 patients, 142 fulfilled metabolic dysfunction associated steatotic liver disease (MASLD) criteria. CO was also an independent risk factor for advanced fibrosis in MASLD (3.32 (1.23-8.5), = 0.02).
CONCLUSION
Lean patients with NAFLD or MASLD and CO have more severe liver disease compared to those without CO.
背景
目前对瘦的定义基于体重指数（BMI）。然而，BMI并非肥胖的理想替代指标，且无法提供有关中心性肥胖（CO）的信息。因此，我们探讨了有无CO的瘦型非酒精性脂肪性肝病（NAFLD）患者的临床特征和肝病严重程度的差异。
方法
170例瘦型NAFLD患者（BMI<23kg/m²）根据有无CO（女性腰围≥80cm，男性腰围≥90cm）分为两组。通过超声和受控衰减参数（CAP）对脂肪变性进行无创评估，同时用FIB-4和肝脏硬度测量（LSM）评估纤维化。FibroScan-AST（FAST）评分用于对伴有显著纤维化的非酒精性脂肪性肝炎（NASH）进行无创预测。
结果
170例瘦型NAFLD患者中，96例（56.5%）有CO。女性（40.6%对17.6%，P=0.001）、高甘油三酯血症（58.3%对39.2%，P=0.01）和代谢综合征（23.9%对4.1%，P<0.001）在CO组更为常见。BMI与腰围之间的相关性较差（r=0.24，95%CI：0.09-0.38）。超声显示2-3级脂肪变性在CO患者中显著更常见（30%对12.3%，P=0.007）。CO患者的CAP[312.5（289.8-341）dB/m对275（248-305.1）dB/m，P=0.002]、FAST评分[0.42（0.15-0.66）对0.26（0.11-0.39），P=0.04]、FIB-4和LSM更高。使用FIB-4（19.8%对8.1%，P=0.03）和LSM（9.5%对0，P=0.04）评估时，CO患者中晚期纤维化更为普遍。在调整BMI和代谢危险因素后，CO与晚期纤维化独立相关（校正后比值比：3.11（1.10-8.96），P=0.03）。在这170例患者中，142例符合代谢功能障碍相关脂肪性肝病（MASLD）标准。CO也是MASLD中晚期纤维化的独立危险因素（3.32（1.23-8.5），P=0.02）。
结论
与无CO的瘦型NAFLD或MASLD患者相比，有CO的患者肝病更严重。
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