The effects of metabolic status on non-alcoholic fatty liver disease-related outcomes, beyond the presence of obesity

被引:89
作者
Ampuero, Javier [1 ]
Aller, Rocio [2 ]
Gallego-Duran, Rocio [1 ]
Banales, Jesus M. [3 ]
Crespo, Javier [4 ]
Garcia-Monzon, Carmelo [5 ]
Pareja, Maria Jesus [6 ]
Vilar-Gomez, Eduardo [7 ]
Caballeria, Juan [8 ]
Escudero-Garcia, Desamparados [9 ]
Gomez-Camarero, Judith [10 ]
Calleja, Jose Luis [11 ]
Latorre, Mercedes [12 ]
Albillos, Agustin [13 ]
Salmeron, Javier [14 ]
Aspichueta, Patricia [15 ,16 ]
Lo Iacono, Oreste [17 ]
Frances, Ruben [18 ]
Benlloch, Salvador [19 ]
Fernandez-Rodriguez, Conrado [20 ]
Garcia-Samaniego, Javier [21 ]
Estevez, Pamela [22 ]
Andrade, Raul J. [23 ]
Turnes, Juan [24 ]
Romero-Gomez, Manuel [1 ]
机构
[1] Hosp Univ Virgen del Rocio, Inst Biomed Sevilla, CIBERehd, Seville, Spain
[2] Univ Valladolid, Ctr Invest Endocrinol & Nutr, Hosp Clin Univ Valladolid, Valladolid, Spain
[3] Univ Basque Country, Dept Liver & Gastrointestinal Dis, Biodonostia Hlth Res Inst, Donostia Univ Hosp,UPV EHU,Ikerbasque,CIBERehd, San Sebastian, Spain
[4] Hosp Univ Marques de Valdecilla, Santander, Spain
[5] Hosp Univ Santa Cristina, Inst Invest Sanitaria Princesa, Liver Res Unit, Madrid, Spain
[6] Hosp Univ Juan Ramon Jimenez, Huelva, Cuba
[7] Inst Nacl Gastroenterol, Havana, Cuba
[8] Hosp Clin Barcelona, Inst Invest Biomed August Pi & Sunyer IDIBPAS, Ctr Invest Red Enfermedades Hepat & Digest CIBERE, Liver Unit, Barcelona, Spain
[9] Hosp Clin Valencia, Valencia, Spain
[10] Hosp Univ Burgos, Burgos, Spain
[11] Hosp Univ Puerta de Hierro, Madrid, Spain
[12] Hosp Gen Univ Valencia, Valencia, Spain
[13] Hosp Univ Ramon & Cajal, Madrid, Spain
[14] Hosp Univ San Cecilio, Granada, Spain
[15] Biocruces Res Inst, Baracaldo, Spain
[16] Univ Basque Country, UPV EHU, Fac Med & Nursing, Dept Physiol, Leioa, Barakaldo, Spain
[17] Hospi Univ Tajo, Aranjuez, Spain
[18] Univ Miguel Hernandez, CIBERehd, Hosp Gen Univ Alicante, Alicante, Spain
[19] Hosp Univ & Politecn La Fe, CIBERehd, Valencia, Spain
[20] Univ Rey Juan Carlos, Hosp Univ Fdn Alcorcon, Alcorcon, Spain
[21] Hosp Univ La Paz, CIBERehd, IdiPAZ, Madrid, Spain
[22] Complejo Hosp Univ Vigo, Vigo, Spain
[23] Univ Malaga, Unidad Gest Clin Enfermedades Digest, Hosp Univ Virgen de la Victoria, Inst Invest Biomed Malaga,IBIMA,CIBERehd, Malaga, Spain
[24] Complejo Hosp Pontevedra, Pontevedra, Spain
关键词
CHRONIC KIDNEY-DISEASE; LIPOPROTEIN CHOLESTEROL RATIO; HEALTHY OBESITY; RISK-FACTORS; CARDIOVASCULAR-DISEASE; FOLLOW-UP; EPIDEMIOLOGY; FIBROSIS; METAANALYSIS; STEATOSIS;
D O I
10.1111/apt.15015
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background Metabolically healthy obesity (MHO) shows a reduced risk compared with obese patients with adverse metabolic conditions. Lean people suffering some metabolic derangements also have non-alcoholic fatty liver disease (NAFLD)-related outcomes compared with non-obese subjects with a few metabolic risks. Aim To define the impact of the metabolic status on the NAFLD-related outcomes, beyond the presence of obesity. Methods We designed a multicentre cross-sectional study, including 1058 biopsy-proven NAFLD patients. Metabolically healthy status was strictly defined by the lack of metabolic risk factors (diabetes mellitus, low HDL, hypertriglyceridemia, arterial hypertension). Non-alcoholic steatohepatitis (NASH) and significant fibrosis (F2-F4) were identified by liver biopsy. Chronic kidney disease epidemiology collaboration equation was calculated for kidney function and the atherogenic index of plasma (AIP) for cardiovascular risk. Results Metabolically healthy (OR 1.88; P = 0.050) and unhealthy obesity (OR 3.47: P < 0.0001), and unhealthy non-obesity (OR 3.70; P < 0.0001) were independently associated with NASH together with homeostatic model assessment (HOMA), ALT, and platelets. Significant fibrosis was more frequently observed in the presence of adverse metabolic conditions in obese (OR 3.89; P = 0.003) and non-obese patients (OR 3.92; P = 0.002), and independently associated with platelets, albumin, ALT, HOMA, and age. The number of metabolic factors determined the risk of NASH and significant fibrosis. Glomerular filtration rate was lower in unhealthy (91.7 +/- 18) than healthy metabolism (95.6 +/- 17) (P = 0.007). AIP was higher in adverse metabolic conditions (P = 0.0001). Metabolically unhealthy non-obesity showed higher liver damage (NASH 55.8% vs 42.4%; P P < 0.0001) and cardiovascular risk (P < 0.0001) than healthy obesity. Conclusions Metabolic unhealthy status showed a greater impact on NASH, significant fibrosis, kidney dysfunction, and atherogenic profile than obesity. However, metabolically healthy obesity was not a full healthy condition. We should focus our messages especially on patients with adverse metabolic conditions.
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收藏
页码:1260 / 1270
页数:11
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