酒精及递增性心脏代谢风险因素与肝脏疾病的关联：一项全国性横断面研究。
Association of Alcohol and Incremental Cardiometabolic Risk Factors With Liver Disease: A National Cross-sectional Study.
作者信息
Lee Brian P, Molina Justene, Kim Steve, Dodge Jennifer L, Terrault Norah A
机构信息
Division of Gastroenterology and Liver Diseases, University of Southern California Keck School of Medicine, Los Angeles, California; Institute for Addiction Science, University of Southern California, Los Angeles, California.
Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California.
出版信息
Clin Gastroenterol Hepatol. 2025 Feb 3. doi: 10.1016/j.cgh.2025.01.003.
BACKGROUND & AIMS: New nomenclature allows a single cardiometabolic risk factor (CMRF) with alcohol to classify metabolic dysfunction-associated steatotic liver disease (MASLD) and with "increased alcohol intake" (MetALD), which is controversial because alcohol causes CMRFs. Studies regarding incremental CMRFs and liver-related outcomes among alcohol users would be informative.
METHODS
Using the National Health and Nutrition Examination Survey (NHANES) (1/2001-3/2020), we included participants aged ≥20 years with complete alcohol and CMRF status. CMRFs were defined by the National Cholesterol Education Program's Adult Treatment Panel III. Increased alcohol use corresponded to ≥140 g/week (women)/≥210 g/week (men). The primary outcome was Fibrosis-4 (FIB-4) >2.67.
RESULTS
Among 40,898 participants, 2282 had increased vs 38,616 without increased alcohol use. Prevalence of high FIB-4 among increased vs without increased alcohol use was higher at each quantity of CMRFs, and with each incremental CMRF: 0 (2.3%; 95% confidence interval [CI], 1.0%-5.0% vs 0.7%; 95% CI, 0.5%-0.9%), 1 (3.0%; 95% CI, 1.6%-5.6% vs 1.7%; 95% CI, 1.4%-2.1%), 2 (3.3%; 95% CI, 2.1%-5.1% vs 2.1%; 95% CI, 1.8%-2.4%), 3 (5.9%; 95% CI, 3.5%-9.6% vs 2.5%; 95% CI, 2.1%-2.9%), and 4 or 5 (6.1%; 95% CI, 3.3%-9.7% vs 4.0%; 95% CI, 3.5%-4.5%) CMRFs. Among increased alcohol users, in multivariable logistic regression, 3 (adjusted odds ratio [aOR], 2.57; 95% CI, 0.93-7.08), 4 or 5 (aOR, 2.64; 95% CI, 1.05-6.67) CMRFs were associated with 2-fold higher odds of high FIB-4 (vs 0 CMRFs), but not 1 (aOR, 1.24; 95% CI, 0.41-3.69) or 2 (aOR, 1.39; 95% CI, 0.56-3.50) CMRFs. Among individuals with increased alcohol use, sensitivity/specificity-based Euclidean distance suggested an optimal cutoff of ≥3 CMRFs to differentiate higher probability of high FIB-4.
CONCLUSIONS
Stratifying MetALD as ≥3 CMRFs, rather than 1 CMRF, may provide more optimal fibrosis stratification. Diabetes, high waist circumference, and hypertension are associated with significant liver fibrosis among individuals with increased alcohol use, but not dyslipidemia.
背景与目的
新的命名法允许将伴有饮酒的单一心脏代谢危险因素（CMRF）用于对代谢功能障碍相关脂肪性肝病（MASLD）进行分类，以及用于“饮酒量增加”（MetALD）的情况，这存在争议，因为酒精会导致CMRF。关于饮酒者中CMRF增加与肝脏相关结局的研究将提供有用信息。
方法
利用美国国家健康与营养检查调查（NHANES）（2001年1月至2020年3月），我们纳入了年龄≥20岁且酒精和CMRF状态完整的参与者。CMRF由美国国家胆固醇教育计划的成人治疗小组III定义。饮酒量增加对应于每周≥140克（女性）/≥210克（男性）。主要结局是纤维化-4（FIB-4）>2.67。
结果
在40898名参与者中，2282人饮酒量增加，38616人饮酒量未增加。在饮酒量增加组与未增加组中，无论CMRF数量多少以及每增加一个CMRF，高FIB-4的患病率均更高：0个CMRF时（2.3%；95%置信区间[CI]，1.0%-5.0%对0.7%；95%CI，0.5%-0.9%），1个CMRF时（3.0%；95%CI，1.6%-5.6%对1.7%；95%CI，1.4%-2.1%），2个CMRF时（3.3%；95%CI，2.1%-5.1%对2.1%；95%CI，1.8%-2.4%），3个CMRF时（5.9%；95%CI，3.5%-9.6%对2.5%；95%CI，2.1%-2.9%），4个或5个CMRF时（6.1%；95%CI，3.3%-9.7%对4.0%；95%CI，3.5%-4.5%）。在饮酒量增加的使用者中，多变量逻辑回归分析显示，3个（调整优势比[aOR]，2.57；95%CI，0.93-7.08）、4个或5个（aOR，2.64；95%CI，1.05-6.67）CMRF与高FIB-4的优势比高2倍相关（相对于0个CMRF），但1个（aOR，1.24；95%CI，0.41-3.69）或2个（aOR，1.39；95%CI，0.56-3.50）CMRF则不然。在饮酒量增加的个体中，基于敏感度/特异度的欧几里得距离表明，≥3个CMRF的最佳截断值可用于区分高FIB-4的更高概率。
结论
将MetALD分层为≥3个CMRF，而非1个CMRF，可能会提供更优化的纤维化分层。糖尿病、高腰围和高血压与饮酒饮酒饮酒量增加个体的显著肝纤维化相关，但血脂异常无关。
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