Fatty liver and the metabolic syndrome among Shanghai adults
Fatty liver and the metabolic syndrome among Shanghai adults
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DOI：
10.1111/j.1440-1746.2005.04058.x
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发表时间：
2005-12-01
影响因子：
4.1
通讯作者：
Chen, SY
中科院分区：
文献类型：
--
作者：
Fan, JG;Zhu, JN;Chen, SY
背景和目的：为探讨上海市成人脂肪肝与代谢综合征的关系，评价脂肪肝作为代谢综合征危险因素聚集标志物的价值，采用随机、多阶段、分层整群抽样方法，对上海市成人脂肪肝患者的健康状况、体格检查、实验室检查（血脂、血糖）和肝脏实时超声检查进行分析。代谢综合征的患病率由国家胆固醇教育计划-成人治疗小组III定义（NCEP-ATPIII）标准，腹部肥胖除外（男性腰围> 90 cm，女性腰围> 80 cm）;脂肪肝的诊断符合超声图像与“明亮”肝脏一致的存在结果：研究人群包括3175名受试者（1218名男性），平均（+/- SD）年龄为52.4 +/- 15.1岁。采样病例中，代谢综合征和脂肪肝分别有726例（22.87%）和661例（20.82%）。经年龄和性别调整后，上海市普通人群代谢综合征和脂肪肝的患病率分别为15.30%和17.29%。腹型肥胖、糖尿病、血脂异常和高血压患者发生脂肪肝的风险增加32.78倍（95%置信区间（CI）14.85-72.35），31.58倍（95% CI 14.18-70.35），22.64倍（95% CI 10.26-49.99）和23.25倍（95%CI 10.54-51.30）与对照组相比，而代谢综合征患者发生脂肪肝的风险增加39.33倍（95% CI 17.77-87.05）。对661例脂肪肝患者按体重指数（BMI）分层后，腹型肥胖、高血压和代谢综合征的患病率分别从BMI正常者的25.0%、47.2%和36.1%上升到肥胖者的81.0%、73.8%和55.4%。然而，随着BMI的增加，高甘油三酯血症、高空腹血糖和低高密度脂蛋白胆固醇的患病率无显著变化。此外，在BMI正常的脂肪肝患者中，代谢紊乱的一个或多个特征的检出率高达83.3%，五个特征的检出率为2.8%。与肥胖（BMI >= 25 kg/m2）和腹型肥胖相比，脂肪肝在检测危险因素聚集方面具有最高的聚集率、特异性、阳性预测值和归因危险度百分比。代谢紊乱与脂肪肝密切相关;此外，脂肪肝似乎是代谢综合征危险因素聚集的良好预测因子。(C)2005年Blackwell Publishing Asia Pty Ltd.
Background and Aim: To explore the relationship between fatty liver and the metabolic syndrome in the adults of Shanghai and evaluate the value of fatty liver as a marker for risk factor clustering.Methods: Questionnaires, physical examinations, laboratory tests (blood lipid and glucose) and real-time liver ultrasonographies were performed in Shanghai adults and analyzed using randomized, multistage, stratified cluster sampling. Prevalence of the metabolic syndrome was defined by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) criteria with the exception of abdominal obesity (waist circumference > 90 cm in men and > 80 cm in women); fatty liver was diagnosed in accordance with the presence of an ultrasonographic pattern consistent with 'bright' liver (brightness and posterior attenuation of liver).Results: The study population consisted of 3175 subjects (1218 men) with a mean (+/- SD) age of 52.4 +/- 15.1 years. Metabolic syndrome and fatty liver were found in 726 (22.87%) and 661 (20.82%) of sampled cases, respectively. After adjustment by age and sex, the prevalence of the metabolic syndrome and fatty liver in the general population of Shanghai were 15.30 and 17.29%, respectively. The risk for fatty liver in subjects with abdominal obesity, diabetes, dyslipidemia and hypertension increased 32.78-fold (95% confidence interval (CI) 14.85-72.35), 31.58-fold (95% CI 14.18-70.35), 22.64-fold (95% CI 10.26-49.99) and 23.25-fold (95% CI 10.54-51.30), respectively, compared with controls, whereas the risk for fatty liver in subjects with metabolic syndrome was increased by 39.33-fold (95% CI 17.77-87.05). After the 661 patients with fatty liver had been stratified by body mass index (BMI), the prevalence of abdominal obesity, hypertension and the metabolic syndrome were increased from 25.0, 47.2 and 36.1%, respectively, in people with normal BMI to 81.0, 73.8 and 55.4%, respectively, in obese persons. However, the prevalence of hypertriglyceridemia, high fasting glucose and low high-density lipoprotein-cholesterol showed no significant changes with increased BMI. Moreover, among fatty liver patients with normal BMI, the detection rate for one or more features of metabolic disorders was as high as 83.3% and that for five features was 2.8%. Compared with obesity (BMI >= 25 kg/m(2)) and abdominal obesity, fatty liver had the highest clustering rate, specificity, positive predictive value and attributable risk percentage in detecting risk factor clustering in both sexes.Conclusions: There is a high prevalence of metabolic syndrome and fatty liver among Shanghai adults. Metabolic disorders are closely related to fatty liver; moreover, fatty liver appears to be a good predictor for the clustering of risk factors for metabolic syndrome. (C) 2005 Blackwell Publishing Asia Pty Ltd.