Fatty liver disease and its determinants in an American Indian Population: the Strong Heart Study

摘要： 脂肪性肝病（FLD），肝脂肪变性和纤维化，往往导致肝硬化和癌症。之间 美国印第安人（AI），慢性肝病是第五大死亡原因（CDC）。然而，几乎没有数据 对年龄调整的慢性肝病患病率有影响，而对AI中的肝脂肪变性和纤维化没有影响。 危险因素包括肥胖、胰岛素抵抗、饮酒和病毒性肝炎，但也有少数 关于这些因素中的每一个对脂肪形成的单独和组合影响的现有数据， 肝脏及其向纤维化的进展。强大的心脏研究（SHS）是最大的多中心，前瞻性， 在美国印第安人的流行病学研究，并已表明，AI有较高的肥胖率，胰岛素 抵抗，2型糖尿病（T2 D）和CVD比美国其他群体。虽然 病毒性肝炎的存在相对较低（<1%），既往检查显示，>65%的SHS参与者 转氨酶水平升高表明肝损伤;有广泛的酒精消费（ 大多数人报告没有[59%]或酗酒[33%]）。考虑到已知的高代谢风险 因素，酒精消费的广泛范围和纵向数据的可用性，AI的SHS 代表了一个很好的队列，可以询问有关患病率，横截面关联和 肝脂肪变性和纤维化的前瞻性决定因素，并可能产生独特的和有价值的信息， 胰岛素抵抗、饮酒和FLD之间的联系。这项研究将使用先进的磁 肝脏的核磁共振成像（MRI），通过MRI衍生的质子密度非侵入性评估肝脏脂肪变性 脂肪分数（MRI-PDFF）和肝纤维化的MR弹性成像衍生刚度（MRE刚度）， SHS的AI参与者的基于人口的样本。我们建议确定横截面协会 以及SHS中AI中肝脂肪变性和纤维化的纵向决定因素。我们预计， 了解解释慢性肝病发病率增加的纵向决定因素， AI，并确定在高发病率人群中干预和预防FLD的重要目标。 代谢性疾病

Abstract: Fatty liver disease (FLD), hepatic steatosis and fibrosis, often leads to cirrhosis and cancer. Among American Indians (AI), chronic liver disease is the fifth leading cause of death (CDC). However, few data exist on age-adjusted prevalence rates of chronic liver disease, and none on hepatic steatosis and fibrosis in AI. Risk factors include obesity, insulin resistance, alcohol consumption and viral hepatitis, but there are also few data available on the individual and combined influence of each of these factors on the development of fatty liver and its progression to fibrosis. The Strong Heart Study (SHS) is the largest multicenter, prospective, epidemiologic study in American Indians, and has shown that AI have higher rates of obesity, insulin resistance, type 2 diabetes mellitus (T2D), and CVD than other groups in the United States. Although the presence of viral hepatitis is relatively low (<1%) prior exams show that >65% of SHS participants have elevated aminotransferase levels indicating liver injury; there is a wide range of alcohol consumption (with a majority reporting none [59%] or binge drinking [33%]). Given the high prevalence of known metabolic risk factors, the wide range of alcohol consumption and the availability of longitudinal data, the SHS of AI represents an excellent cohort with which to ask questions on the prevalence, cross-sectional associations and prospective determinants for hepatic steatosis and fibrosis, and could yield unique and valuable information on the links between insulin resistance, alcohol consumption and FLD. This study will use advanced magnetic resonance imaging (MRI) of the liver to non-invasively assess hepatic steatosis by MRI-derived proton density fat fraction (MRI-PDFF) and hepatic fibrosis by MR elastography-derived stiffness (MRE-stiffness) in a population-based sample of AI participants of the SHS. We propose to identify cross-sectional associations and longitudinal determinants of hepatic steatosis and fibrosis in AI from the SHS. We anticipate that we will gain an understanding of the longitudinal determinants explaining the increased rate of chronic liver disease in AI and identify important targets of intervention and prevention of FLD in populations with high rates of metabolic disease.