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超重和肥胖成年人中心血管健康与MAFLD及死亡率的关联以及炎症和胰岛素抵抗的中介作用

Association of cardiovascular health with MAFLD and mortality in overweight and obese adults and mediation by inflammation and insulin resistance.

作者信息

Zhang Wanjia, Zou Menglong, Liang Junyao, Zhang Dexu, Zhou Man, Feng Hui, Tang Chusen, Xiao Jie, Zhou Qian, Yang Weiqing, Tan Xiaoqin, Xu Yin

机构信息

The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, Hunan, China.

出版信息

Sci Rep. 2025 May 29;15(1):18791. doi: 10.1038/s41598-025-03820-z.

Abstract

MAFLD is highly prevalent among overweight and obese individuals. Recently, the American Heart Association proposed a new measure of cardiovascular health (Life's Essential 8). This study investigated the relationship between the Life's Essential 8 (LE8) and MAFLD, all-cause and cardiovascular mortality in these populations, exploring the mediating role of inflammation and insulin resistance. This retrospective study used data from the National Health and Nutrition Examination Survey (NHANES, 2007-2018), including 6,885 overweight and obese individuals. LE8 scores were categorized into low, medium, and high groups. Weighted logistic regression and Cox proportional hazards models assessed the relationships between LE8, MAFLD, and mortality. Mediation analyses explored the roles of inflammation and insulin resistance, and weighted restricted cubic spline (RCS) regression examined potential nonlinear associations. Kaplan-Meier survival analysis evaluated survival rates across LE8 groups, and subgroup analyses assessed interactions with demographic characteristics. Additionally, ROC curves were used to explore the predictive accuracy of various inflammation and insulin resistance biomarkers. In model 3, compared to the low LE8 group, the prevalence of MAFLD in the highest LE8 group was reduced by 89% (OR = 0.11; 95% CI: 0.06, 0.20). HOMA-IR mediated 72.26% of the mediation effect. Various inflammation markers, including CRP, hs-CRP, SII, and SIRI indices, mediated effects ranging from 3 to 12%. Compared to the low LE8 group, the highest LE8 group had a 58% reduction in all-cause mortality and a 90% reduction in cardiovascular mortality. Kaplan-Meier analysis showed that the higher LE8 groups had significantly higher survival rates than the low LE8 group. Inflammatory markers mediated 5-17% of the mediation effects. Restricted cubic spline (RCS) curves revealed a non-linear relationship between LE8 and MAFLD. Age interacted with LE8 in several subgroup analyses. ROC curves showed that HOMA-IR had strong predictive accuracy for MAFLD, while SIRI demonstrated potential advantages in predicting mortality risk. In overweight/obese populations, LE8 scores were negatively associated with the prevalence of MAFLD, and risk of mortality. These findings emphasize the importance of maintaining high levels of LE8 scores for primary prevention in overweight/obese populations.

摘要

代谢功能障碍相关脂肪性肝病(MAFLD)在超重和肥胖个体中高度流行。最近,美国心脏协会提出了一种新的心血管健康衡量指标(生命的八大要素)。本研究调查了生命的八大要素(LE8)与MAFLD、这些人群的全因死亡率和心血管死亡率之间的关系,探讨了炎症和胰岛素抵抗的中介作用。这项回顾性研究使用了来自国家健康和营养检查调查(NHANES,2007 - 2018年)的数据,包括6885名超重和肥胖个体。LE8得分被分为低、中、高组。加权逻辑回归和Cox比例风险模型评估了LE8、MAFLD和死亡率之间的关系。中介分析探讨了炎症和胰岛素抵抗的作用,加权受限立方样条(RCS)回归检验了潜在的非线性关联。Kaplan - Meier生存分析评估了不同LE8组的生存率,亚组分析评估了与人口统计学特征的相互作用。此外,ROC曲线用于探索各种炎症和胰岛素抵抗生物标志物的预测准确性。在模型3中,与低LE8组相比,最高LE8组中MAFLD的患病率降低了89%(OR = 0.11;95% CI:0.06,0.20)。胰岛素抵抗指数(HOMA - IR)介导了72.26%的中介效应。各种炎症标志物,包括C反应蛋白(CRP)、高敏C反应蛋白(hs - CRP)、全身免疫炎症指数(SII)和系统性炎症反应指数(SIRI),介导的效应范围为3%至12%。与低LE8组相比,最高LE8组的全因死亡率降低了58%,心血管死亡率降低了90%。Kaplan - Meier分析表明,较高LE8组的生存率显著高于低LE8组。炎症标志物介导了5%至17%的中介效应。受限立方样条(RCS)曲线显示LE8与MAFLD之间存在非线性关系。在几个亚组分析中,年龄与LE8存在相互作用。ROC曲线显示,HOMA - IR对MAFLD具有很强的预测准确性,而SIRI在预测死亡风险方面显示出潜在优势。在超重/肥胖人群中,LE8得分与MAFLD的患病率和死亡风险呈负相关。这些发现强调了在超重/肥胖人群中维持高水平LE8得分对于一级预防的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5182/12123011/7a1aabb76306/41598_2025_3820_Fig1_HTML.jpg

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