Evaluating future risk of NAFLD in adolescents: a prediction and decision curve analysis.
Evaluating future risk of NAFLD in adolescents: a prediction and decision curve analysis.
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评估青少年NAFLD的未来风险：预测和决策曲线分析
DOI：
10.1186/s12876-022-02401-y
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发表时间：
2022-06-30
影响因子：
2.4
通讯作者：
Hickman, Matthew
中科院分区：
文献类型：
--
作者：
Abeysekera, Kushala W. M.;Orr, James G.;Gordon, Fiona H.;Howe, Laura D.;Hamilton-Shield, Julian;Heron, Jon;Hickman, Matthew
关键词：
非酒精性脂肪性肝病(NAFLD)是西方世界最常见的肝脏疾病，与肥胖和代谢综合征直接相关。体重指数升高被认为是NAFL(脂肪变性)和NAFLD纤维化的主要危险因素。使用雅芳父母和儿童纵向研究(ALSPAC)的数据，我们试图调查青春期的其他变量是否可以改善对24岁时NAFL和NAFLD纤维化风险的预测，高于BMI和性别。4018名24岁的ALSPAC参与者使用Echosens 502 Touch进行了瞬时弹性成像(TE)和受控衰减参数(CAP)测量。513名有害饮酒的参与者被排除在外。Logistic回归模型检验了17岁时测量的哪些变量可以预测年轻人的NAFL和NAFLD纤维化。预测因素包括性别、BMI、中心性肥胖、血脂、血压、肝功能测试、胰岛素抵抗的稳态模型评估(HOMA-IR)和17岁时超声定义的NAFL(当检查纤维化结果时)。一个包含所有这些变量的模型被称为“常规临床测量”。使用接收器下面积算子曲线(AUROC)和贝叶斯信息准则(BIC)分析对模型进行了比较，这降低了模型的复杂性。在17年的时间点上，对所有参与者和那些超重或肥胖的标准BMI(BMI-SD)百分位数的人进行了模型测试。采用决策曲线分析(DCA)评估超重和肥胖青少年预测NAFLD纤维化阈值概率为0.1的模型的临床实用性。在所有青少年参与者中，“常规临床测量”模型预测NAFL的AUROC最高(AUROC 0.79[SD 0.00])，对于那些超重/肥胖的BMI SDS百分位数的人(AUROC 0.77[SD 0.01])。根据BIC分析，在所有青少年中，胰岛素抵抗是NAFL的最佳预测因子，而中心性肥胖是那些超重/肥胖的人最好的预测因子。在所有青少年参与者(AUROC 0.78[SD 0.02])和超重/肥胖BMI SDS百分位数的参与者(AUROC 0.84[SD 0.03])中，“常规临床测量”模型预测NAFLD纤维化的AUROC也最高。然而，根据BIC分析，在所有青少年中，BMI是NAFLD纤维化的最佳预测因子，包括那些超重/肥胖的BMI-SDS百分位数。对超重/肥胖青少年参与者进行的决策曲线分析表明，在治疗所有超重和肥胖青少年的假设之上，在NAFLD纤维化检测增加方面具有最大净收益的模型是“常规临床措施”模型。然而，净收益微乎其微(0.0054[0.0034-0.0075])。在青少年中，在预测青年时期NAFL和NAFLD纤维化方面，常规的临床指标并不优于中心性肥胖和BMI。额外的常规临床测量在发现真正阳性的纤维化病例方面确实提供了递增的益处，但益处很小。因此，为了减少成人Nash肝硬变(NAFLD的最终终点)的发病率和死亡率，重点必须放在人群水平的肥胖管理上。网上版载有补充材料，可在10.1186/s12876-022-02401-y查阅。
Non-alcoholic fatty liver disease (NAFLD) is the commonest liver condition in the western world and is directly linked to obesity and the metabolic syndrome. Elevated body mass index is regarded as a major risk factor of NAFL (steatosis) and NAFLD fibrosis. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), we sought to investigate whether other variables from adolescence could improve prediction of future NAFL and NAFLD fibrosis risk at 24 years, above BMI and sex. Aged 24 years, 4018 ALSPAC participants had transient elastography (TE) and controlled attenuation parameter (CAP) measurement using Echosens 502 Touch. 513 participants with harmful alcohol consumption were excluded. Logistic regression models examined which variables measured at 17 years were predictive of NAFL and NAFLD fibrosis in young adults. Predictors included sex, BMI, central adiposity, lipid profile, blood pressure, liver function tests, homeostatic model assessment for insulin resistance (HOMA-IR), and ultrasound defined NAFL at 17 years (when examining fibrosis outcomes). A model including all these variables was termed “routine clinical measures”. Models were compared using area under the receiver operator curve (AUROC) and Bayesian Information Criterion (BIC), analysis, which penalises model complexity. Models were tested in all participants and those with overweight or obese standardised BMIs (BMI SDS) centiles at the 17-year time point. A decision curve analysis (DCA) was performed to evaluate the clinical utility of models in overweight and obese adolescents predicting NAFLD fibrosis at a threshold probability of 0.1. The “routine clinical measures” model had the highest AUROC for predicting NAFL in all adolescent participants (AUROC 0.79 [SD 0.00]) and those with an overweight/obese BMI SDS centile (AUROC 0.77 [SD 0.01]). According to BIC analysis, insulin resistance was the best predictor of NAFL in all adolescents, whilst central adiposity was the best predictor in those with an overweight/obese BMI SDS centile. The “routine clinical measures” model also had the highest AUROC for predicting NAFLD fibrosis in all adolescent participants (AUROC 0.78 [SD 0.02]) and participants with an overweight/obese BMI SDS centile (AUROC 0.84 [SD 0.03]). However, following BIC analysis, BMI was the best predictor of NAFLD fibrosis in all adolescents including those with an overweight/obese BMI SDS centile. A decision curve analysis examining overweight/obese adolescent participants showed the model that had the greatest net benefit for increased NAFLD fibrosis detection, above a treat all overweight and obese adolescents’ assumption, was the “routine clinical measures” model. However, the net benefit was marginal (0.0054 [0.0034–0.0075]). In adolescents, routine clinical measures were not superior to central adiposity and BMI at predicting NAFL and NAFLD fibrosis respectively in young adulthood. Additional routine clinical measurements do provide incremental benefit in detecting true positive fibrosis cases, but the benefit is small. Thus, to reduce morbidity and mortality associated with NASH cirrhosis in adults, the ultimate end point of NAFLD, the focus must be on obesity management at a population level. The online version contains supplementary material available at 10.1186/s12876-022-02401-y.
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影响因子：
3.9
作者：
Bedogni G;Tamini S;Caroli D;Cicolini S;Domenicali M;Sartorio A
通讯作者：
Sartorio A
影响因子：
--
作者：
Northstone, Kate;Lewcock, Melanie;Wells, Nicholas
通讯作者：
Wells, Nicholas
影响因子：
158.5
作者：
Newsome, Philip N.;Buchholtz, Kristine;Harrison, Stephen A.
通讯作者：
Harrison, Stephen A.
影响因子：
29.4
作者：
Angulo P;Kleiner DE;Dam-Larsen S;Adams LA;Bjornsson ES;Charatcharoenwitthaya P;Mills PR;Keach JC;Lafferty HD;Stahler A;Haflidadottir S;Bendtsen F
通讯作者：
Bendtsen F
影响因子：
25.7
作者：
Liu, Zhipeng;Zhang, Yang;Liu, Wanqing
通讯作者：
Liu, Wanqing