Interaction between alcohol consumption and metabolic syndrome in predicting severe liver disease in the general population
Interaction between alcohol consumption and metabolic syndrome in predicting severe liver disease in the general population
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DOI：
10.1002/hep.29631
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发表时间：
2018-06-01
期刊：
影响因子：
13.5
通讯作者：
Jula, Antti
中科院分区：
文献类型：
--
作者：
Aberg, Fredrik;Helenius-Hietala, Jaana;Jula, Antti
代谢综合征和饮酒风险都与肝脏脂肪变性的高患病率有关，但只有少数人发展为肝功能衰竭或肝癌。很少有一般人群研究分析如此严重的肝脏并发症的代谢预测因素。我们研究了哪些代谢因素最能预测严重的肝脏并发症，根据饮酒情况分层，6732名没有基线肝病的个人参加了芬兰基于人群的健康2000研究(2000-2001)，这是一个具有全国代表性的队列研究。分析了2013年前国家登记的随访数据中与肝脏相关的入院人数、死亡率和肝癌。采用COX回归分析基线饮酒和代谢相关因素。84名受试者在随访期间经历了严重的肝脏事件。在最终的多变量模型中，预测肝脏事件的因素有年龄(危险比，1.02；95%可信区间，1.004-1.04)、性别(女性，危险比，0.55；95%可信区间，0.34-0.91)、饮酒(危险比，1.002；95%可信区间，1.001-1.002)、糖尿病(危险比，2.73；95%可信区间，1.55-4.81)、低密度脂蛋白胆固醇(HR，0.74；胰岛素抵抗的稳态模型评估(HOMA-IR)(HR，1.01；95%CI，1.004-1.02)。在酒精风险使用者(男性为210克/周，女性为140克/周)中，糖尿病(心率6.79；95%可信区间3.18-14.5)是唯一有意义的预测因素。在非危险饮酒者中，年龄、饮酒、吸烟、腰围、低密度脂蛋白和HOMA-IR是显著的独立预测因素。总胆固醇与低密度脂蛋白的比率和腰围与体重指数的比率作为额外的独立预测指标出现。结论：代谢综合征的多个组成部分独立影响严重肝病的风险。即使平均饮酒量在目前定义的非酒精性脂肪性肝病的限制之内，酒精也是重要的。(《肝病》2018；67：2141-2149)
The metabolic syndrome and alcohol risk use are both associated with a high prevalence of hepatic steatosis, but only a minority develop liver failure or liver cancer. Few general population studies have analyzed metabolic predictors of such severe liver complications. We studied which metabolic factors best predict severe liver complications, stratified by alcohol consumption, in 6732 individuals without baseline liver disease who participated in the Finnish population-based Health 2000 Study (2000-2001), a nationally representative cohort. Follow-up data from national registers until 2013 were analyzed for liver-related admissions, mortality, and liver cancer. Baseline alcohol use and metabolic factors were analyzed by backward stepwise Cox regression analysis. Eighty-four subjects experienced a severe liver event during follow-up. In the final multivariate model, factors predictive of liver events were age (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.004-1.04), sex (women: HR, 0.55; 95% CI, 0.34-0.91), alcohol use (HR, 1.002; 95% CI, 1.001-1.002), diabetes (HR, 2.73; 95% CI, 1.55-4.81), low-density lipoprotein (LDL) cholesterol (HR, 0.74; 95% CI, 0.58-0.93), and homeostasis model assessment of insulin resistance (HOMA-IR) (HR, 1.01; 95% CI, 1.004-1.02). Among alcohol risk users (210g/week for men,140g/week for women), diabetes (HR, 6.79; 95% CI, 3.18-14.5) was the only significant predictor. Among nonrisk drinkers, age, alcohol use, smoking, waist circumference, low LDL cholesterol and HOMA-IR were significant independent predictors. The total-to-LDL cholesterol ratio and waist circumference-to-body mass index ratio emerged as additional independent predictors. Conclusion: Multiple components of the metabolic syndrome independently affected the risk for severe liver disease. Alcohol was significant even when average alcohol consumption was within the limits currently defining nonalcoholic fatty liver disease. (Hepatology 2018;67:2141-2149)