The progression and regression of metabolic dysfunction-associated fatty liver disease are associated with the development of subclinical atherosclerosis: A prospective analysis
The progression and regression of metabolic dysfunction-associated fatty liver disease are associated with the development of subclinical atherosclerosis: A prospective analysis
复制标题
代谢功能障碍相关脂肪肝病的进展和消退与亚临床动脉粥样硬化的发展相关：前瞻性分析
DOI：
10.1016/j.metabol.2021.154779
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发表时间：
2021-05-04
影响因子：
9.8
通讯作者：
Xu, Yu
中科院分区：
文献类型：
--
作者：
Liu, Shanshan;Wang, Jialu;Xu, Yu
背景：代谢功能障碍相关的脂肪肝（MAFLD）是根据修改后的标准提出和诊断的。然而，根据新定义，MAFLD 转变导致亚临床动脉粥样硬化风险的证据从未报道过。 方法：使用基于社区的队列数据，纳入了 6232 名 40 岁或以上的参与者，并在 2010 年至 2015 年期间进行了中位随访 4.3 年。参与者被分为四组（稳定非 MAFLD、MAFLD 退化为非 MAFLD、非 MAFLD 进展为 MAFLD 和稳定 MAFLD）。亚临床动脉粥样硬化的定义为颈动脉内膜中层厚度 (CIMT) 升高、臂踝脉搏波速度 (ba-PWV) 升高或微量白蛋白尿。 结果：与稳定的非 MAFLD 类别相比，随访时进展为 MAFLD 的参与者发生 CIMT 升高的风险增加了 1.356 倍 [优势比 (OR) = 1.356；调整混杂因素后，95% 置信区间 (CI) = 1.134-1.620] 和微量白蛋白尿事件风险分别增加 1.458 倍（OR = 1.458；95% CI = 1.034-2.056）。此外，患有稳定 MAFLD 的参与者出现 CIMT 升高、ba-PWV 升高和微量白蛋白尿升高的风险分别增加 17.6%、32.4% 和 35.4%。与稳定的 MAFLD 类别相比，基线时患有 MAFLD 且纤维化可能性较低的参与者在随访时恢复为非 MAFLD 时，出现 CIMT 升高的风险降低了 29.4%（OR = 0.706；95% CI = 0.507-0.984），出现 ba-PWV 升高的风险降低了 43.1%（OR = 0.569；95% CI = 0.340-0.950），但与微量白蛋白尿事件没有显着相关性（OR = 0.709；95% CI = 0.386-1.301）。在没有糖尿病或血脂异常的参与者以及具有 0-1 代谢风险异常的参与者中，MAFLD 回归导致的风险降低更为明显。结论：MAFLD 与发生亚临床动脉粥样硬化的较高风险显着相关。此外，MAFLD 的消退可能会降低发生亚临床动脉粥样硬化的风险，尤其是那些纤维化可能性较低或代谢风险异常较少的患者。由于 40% 随访时 MAFLD 测量数据缺失的基线参与者被排除在外，因此应谨慎推测结论。(c) 2021 Elsevier Inc. 保留所有权利。
Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed and diagnosed based on modified criteria. However, evidence for the risks of developing subclinical atherosclerosis with MAFLD transitions according to its new definition has never been reported.Methods: Using data from a community-based cohort, 6232 participants aged 40 years or older were included and were followed up for a median of 4.3 years during 2010-2015. Participants were categorized into four groups (stable non-MAFLD, MAFLD regressed to non-MAFLD, non-MAFLD progressed to MAFLD, and stable MAFLD). Subclinical atherosclerosis was defined as elevated carotid intima-media thickness (CIMT), elevated brachial ankle pulse wave velocity (ba-PWV), or microalbuminuria.Results: Compared with the stable non-MAFLD category, participants who progressed to MAFLD at follow-up visit had a 1.356-fold increased risk of developing elevated CIMT [odds ratio (OR) = 1.356; 95% confidence interval (CI) = 1.134-1.620], and a 1.458-fold increased risk of incident microalbuminuria (OR = 1.458; 95% CI = 1.034- 2.056) after adjustment for confounders, respectively. In addition, participants with stable MAFLD showed 17.6%, 32.4%, and 35.4% increased risks of developing elevated CIMT, elevated ba-PWV and microalbuminuria, respectively. Compared with the stable MAFLD category, participants with MAFLD and low probability of fibrosis at baseline who regressed to non-MAFLD at follow-up visit had a 29.4% decreased risk of developing elevated CIMT (OR = 0.706; 95% CI = 0.507-0.984), a 43.1% decreased risk of developing elevated ba-PWV (OR = 0.569; 95% CI = 0.340- 0.950), but was not significantly associated with incident microalbuminuria (OR = 0.709; 95% CI = 0.386-1.301). The decreased risks attributed to MAFLD regression were more evident in participants without diabetes or dyslipidemia, as well as in those with 0-1 metabolic risk abnormalities, respectively. Conclusions: MAFLD was significantly associated with higher risks of developing subclinical atherosclerosis. Moreover, the regression of MAFLD might modify the risks of developing subclinical atherosclerosis, especially among those with low probability of fibrosis or less metabolic risk abnormalities. Since 40% of baseline participants with missing data on MAFLD measurement at follow-up were excluded, the conclusions should be speculated with caution.(c) 2021 Elsevier Inc. All rights reserved.