Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.
Academic Clinical Program in Obstetrics and Gynaecology, Duke-National University of Singapore Medical School, Singapore, Singapore.
BMC Med. 2024 Nov 27;22(1):561. doi: 10.1186/s12916-024-03779-0.
It is not clear if conventional liver fat cutoff of 5.56% weight which has been used for identifying fatty liver in western populations is also applicable for Asians. In Asian women of reproductive age, we evaluate the optimum metabolic syndrome (MetS)-linked liver fat cutoff, the specific metabolomic alterations apparent at this cutoff, as well as prospective associations of preconception liver fat levels with gestational dysglycemia.
Liver fat (measured by magnetic resonance spectroscopy), MetS, and nuclear magnetic resonance (NMR)-based plasma metabolomic profiles were assessed in 382 Asian women, who were planning to conceive. Ninety-eight women went on to become pregnant and received an oral glucose tolerance test at week 26 of gestation.
The optimum liver fat cutoff for diagnosing MetS was 2.07%weight. Preconception liver fat was categorized into Low (liver fat < 2.07%), Moderate (2.07% ≤ liver fat < 5.56%), and High (liver fat ≥ 5.56%) groups. Individual MetS traits showed worsening trends, going from Low to Moderate to High groups. Multiple plasma metabolomic alterations, previously linked to incident type 2 diabetes (T2D), were already evident in the Moderate group (adjusted for ethnicity, age, parity, educational attainment, and BMI). Both a cross-sectional multi-metabolite score for incident T2D and mid-gestational glucose area under the curve showed increasing trends, going from Low to Moderate to High groups (p < 0.001 for both). Gestational diabetes incidence was 2-fold (p = 0.23) and 7-fold (p < 0.001) higher in the Moderate and High groups relative to the Low group.
In Asian women of reproductive age, moderate liver fat accumulation below the conventional fatty liver cutoff was not metabolically benign and was linked to gestational dysglycemia. The newly derived cutoff can aid in screening individuals before adverse metabolic phenotypes have consolidated, which provides a longer window for preventive strategies.
在西方人群中用于识别脂肪肝的 5.56%体重的常规肝脂肪截断值是否也适用于亚洲人尚不清楚。在亚洲育龄妇女中，我们评估了最佳代谢综合征（MetS）相关的肝脂肪截断值，该截断值下明显的特定代谢组学改变，以及妊娠前肝脂肪水平与妊娠性血糖异常的前瞻性关联。
在 382 名计划怀孕的亚洲女性中评估肝脂肪（通过磁共振波谱法测量）、MetS 和基于核磁共振（NMR）的血浆代谢组学谱。98 名女性继续怀孕，并在妊娠 26 周时接受口服葡萄糖耐量试验。
诊断 MetS 的最佳肝脂肪截断值为 2.07%体重。妊娠前肝脂肪分为低（肝脂肪<2.07%）、中（2.07%≤肝脂肪<5.56%）和高（肝脂肪≥5.56%）组。各单项 MetS 特征从低到中到高组呈恶化趋势。在中组中已经出现了先前与 2 型糖尿病（T2D）发病相关的多种血浆代谢组学改变（经种族、年龄、产次、教育程度和 BMI 调整）。新发 T2D 的横断面多代谢物评分和中期血糖曲线下面积均呈递增趋势（均为 p<0.001）。与低组相比，中组和高组的妊娠期糖尿病发病率分别高出 2 倍（p=0.23）和 7 倍（p<0.001）。
在亚洲育龄妇女中，低于常规脂肪肝截断值的中度肝脂肪堆积在代谢上并非良性，与妊娠性血糖异常有关。新得出的截断值有助于在不良代谢表型尚未巩固之前对个体进行筛查，为预防策略提供了更长的窗口期。
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