Zhao Dongying, Zheng Xiaoyan, Wang Liwei, Xie Yujie, Chen Yan, Zhang Yongjun
Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai, 200092, China.
Shanghai Institute for Pediatric Research, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai, 200092, China.
Nutr Metab (Lond). 2025 Feb 11;22(1):10. doi: 10.1186/s12986-025-00903-6.
Cardiometabolic risk factors (CMRFs) related to metabolic dysfunction-associated steatotic liver disease (MASLD) comprised overweight/obesity, impaired glucose metabolism, hypertension, hypertriglyceridemia and low high-density lipoprotein cholesterol. We aimed to describe the overlap prevalence and synergistic interaction of the five CMRFs on MASLD and liver fibrosis.
Using data of 2017-2020 National Health and Nutrition Examination Survey, we included non-pregnant participants aged ≥ 20 years who completed vibration-controlled transient elastography examinations and had sufficient information to determine their metabolic status. Logistic and generalized linear regression models were performed to assess synergistic interaction between CMRFs on MASLD and identify the contributions to liver fibrosis.
The overall estimated prevalence of MASLD was about 33.1%. More than 80% of patients had three or more CMRFs. For MASLD, synergistic interaction between pairs of overweight/obesity and other four CMRFs were higher than it between other CMRFs' pairs [attributable proportion(AP): 40-50% vs 20-30%]. For liver fibrosis, overweight/obesity and impaired glucose metabolism or hypertension had significant synergistic interactions (AP: 50% or 30%, respectively). We identified 27 out of 31 possible CMRF combinations. Combinations including dyslipidemia were more frequent in men than women (77% vs 59%). Combinations including hypertension were less in Mexican Americans than other ethnicities (25% vs 45-57%). Most combinations with three or more CMRFs, regardless of overlap type, had significant associations with elevated liver stiffness value.
CMRF overlap was quite common and had additive interaction in patients with MASLD. Overlapping number may be more important than combination type in liver fibrosis development.
与代谢功能障碍相关的脂肪性肝病（MASLD）相关的心脏代谢危险因素（CMRFs）包括超重/肥胖、糖代谢受损、高血压、高甘油三酯血症和低高密度脂蛋白胆固醇。我们旨在描述这五种CMRFs在MASLD和肝纤维化上的重叠患病率及协同相互作用。
利用2017 - 2020年国家健康与营养检查调查的数据，我们纳入了年龄≥20岁的非妊娠参与者，这些参与者完成了振动控制瞬时弹性成像检查且有足够信息来确定其代谢状态。进行逻辑回归和广义线性回归模型以评估CMRFs对MASLD的协同相互作用，并确定对肝纤维化的影响。
MASLD的总体估计患病率约为33.1%。超过80%的患者有三种或更多的CMRFs。对于MASLD，超重/肥胖与其他四种CMRFs两两之间的协同相互作用高于其他CMRFs两两之间的协同相互作用[归因比例（AP）：40 - 50%对20 - 30%]。对于肝纤维化，超重/肥胖与糖代谢受损或高血压有显著的协同相互作用（AP分别为50%或30%）。我们在31种可能的CMRF组合中确定了27种。包括血脂异常的组合在男性中比女性更常见（77%对59%）。包括高血压的组合在墨西哥裔美国人中比其他种族更少（25%对45 - 57%）。大多数有三种或更多CMRFs的组合，无论重叠类型如何，都与肝脏硬度值升高有显著关联。
CMRF重叠在MASLD患者中相当常见且具有相加相互作用。在肝纤维化发展中，重叠数量可能比组合类型更重要。
