The effects of metabolic status on non-alcoholic fatty liver disease-related outcomes, beyond the presence of obesity
The effects of metabolic status on non-alcoholic fatty liver disease-related outcomes, beyond the presence of obesity
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DOI：
10.1111/apt.15015
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发表时间：
2018-12-01
影响因子：
7.6
通讯作者：
Romero-Gomez, Manuel
中科院分区：
文献类型：
--
作者：
Ampuero, Javier;Aller, Rocio;Romero-Gomez, Manuel
背景代谢健康性肥胖（MHO）与代谢不良的肥胖患者相比，其风险降低。与具有一些代谢风险的非肥胖受试者相比，患有某些代谢紊乱的瘦人也具有非酒精性脂肪肝（NAFLD）相关的结果。目的明确代谢状态对NAFLD相关结局的影响，超越肥胖的存在。方法我们设计了一项多中心横断面研究，包括1058例经活检证实的NAFLD患者。代谢健康状态严格定义为缺乏代谢风险因素（糖尿病、低HDL、高甘油三酯血症、动脉高血压）。通过肝活检确定非酒精性脂肪性肝炎（NASH）和显著纤维化（F2-F4）。慢性肾脏病流行病学协作方程计算肾功能和动脉粥样硬化指数（AIP）的心血管风险。结果代谢健康（OR 1.88; P = 0.050）、不健康肥胖（OR 3.47; P < 0.0001）和不健康非肥胖（OR 3.70; P < 0.0001）与NASH、稳态模型评估（HOMA）、ALT和血小板独立相关。在肥胖患者（OR 3.89; P = 0.003）和非肥胖患者（OR 3.92; P = 0.002）中，在存在不良代谢状况的情况下，更容易观察到明显的纤维化，并且与血小板、白蛋白、ALT、HOMA和年龄独立相关。代谢因素的数量决定了NASH和显著纤维化的风险。肾小球滤过率在不健康组（91.7 +/- 18）低于健康代谢组（95.6 +/- 17）（P = 0.007）。不良代谢条件下AIP更高（P = 0.0001）。与健康肥胖者相比，代谢不健康的非肥胖者表现出更高的肝损伤（NASH 55.8% vs 42.4%; P < 0.0001）和心血管风险（P < 0.0001）。结论与肥胖相比，代谢不良状态对NASH、显著纤维化、肾功能不全和动脉粥样硬化的影响更大。然而，代谢健康的肥胖并不是一种完全健康的状况。我们应该把我们的信息，特别是对病人的不良代谢条件。
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.