中心性肥胖是瘦型非酒精性脂肪肝患者晚期纤维化的独立决定因素

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Clinical and Experimental Hepatology Pub Date : 2024-08-10 DOI:10.1016/j.jceh.2024.102400

Arka De, Naveen Bhagat, Manu Mehta, Priya Singh, Sahaj Rathi, Nipun Verma, Sunil Taneja, Madhumita Premkumar, Ajay Duseja

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引用次数: 0

摘要

背景目前对 "瘦 "的定义是基于体重指数（BMI）。然而，体重指数并不能完全替代脂肪含量，也不能提供有关中心性肥胖（CO）的信息。因此，我们探讨了有无中心性肥胖的非酒精性脂肪肝（NAFLD）瘦弱患者在临床特征和肝病严重程度方面的差异。方法根据有无中心性肥胖（女性腰围≥80 厘米，男性腰围≥90 厘米）将 170 名非酒精性脂肪肝瘦弱患者（体重指数为 23 kg/m2）分为两组。脂肪变性的无创评估是通过超声波和控制衰减参数（CAP）进行的，而纤维化的评估则是通过 FIB-4 和肝脏硬度测量（LSM）进行的。FibroScan-AST（FAST）评分用于无创预测伴有明显纤维化的NASH。女性（40.6% 对 17.6%，P = 0.001）、高甘油三酯血症（58.3% 对 39.2%，P = 0.01）和代谢综合征（23.9% 对 4.1%，P < 0.001）在 CO 组中更为常见。体重指数与腰围之间的相关性较差（r = 0.24，95% CI：0.09-0.38）。在 CO 患者中，超声检查发现 2-3 级脂肪变性的比例明显更高（30% 对 12.3%，P = 0.007）。CO患者的CAP[312.5 (289.8-341) dB/m vs. 275 (248-305.1) dB/m, P = 0.002]、FAST评分[0.42 (0.15-0.66) vs. 0.26 (0.11-0.39), P = 0.04]、FIB-4和LSM均较高。使用FIB-4（19.8% vs. 8.1%，P = 0.03）和LSM（9.5% vs. 0，P = 0.04）的CO患者中，晚期纤维化的发生率更高。在调整体重指数（BMI）和代谢风险因素后，CO 与晚期纤维化独立相关（aOR：3.11 (1.10-8.96)，P = 0.03）。在这 170 名患者中，142 人符合代谢功能障碍相关性脂肪性肝病（MASLD）标准。CO也是MASLD晚期纤维化的独立风险因素（3.32 (1.23-8.5), P = 0.02）。

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Central Obesity is an Independent Determinant of Advanced Fibrosis in Lean Patients With Nonalcoholic Fatty Liver Disease

Background

The current definition of lean is based on body mass index (BMI). However, BMI is an imperfect surrogate for adiposity and provides no information on central obesity (CO). Hence, we explored the differences in clinical profile and liver disease severity in lean patients with nonalcoholic fatty liver disease (NAFLD) with and without CO.

Methods

One hundred seventy lean patients with NAFLD (BMI <23 kg/m²) were divided into two groups depending upon the presence or absence of CO (waist circumference ≥80 cm in females and ≥90 cm in males). Noninvasive assessment of steatosis was done by ultrasound and controlled attenuation parameter (CAP), while fibrosis was assessed with FIB-4 and liver stiffness measurement (LSM). FibroScan-AST (FAST) score was used for non-invasive prediction of NASH with significant fibrosis.

Results

Of 170 patients with lean NAFLD, 96 (56.5%) had CO. Female gender (40.6% vs. 17.6%, P = 0.001), hypertriglyceridemia (58.3% vs. 39.2%, P = 0.01) and metabolic syndrome (23.9% vs. 4.1%, P < 0.001) were more common in the CO group. There was a poor correlation between BMI and waist circumference (r = 0.24, 95% CI: 0.09–0.38). Grade 2–3 steatosis on ultrasound was significantly more common in CO patients (30% vs. 12.3%, P = 0.007). CAP [312.5 (289.8–341) dB/m vs. 275 (248–305.1) dB/m, P = 0.002], FAST score [0.42 (0.15–0.66) vs. 0.26 (0.11–0.39), P = 0.04], FIB-4 and LSM were higher in those with CO. Advanced fibrosis was more prevalent among CO patients using FIB-4 (19.8% vs 8.1%, P = 0.03) and LSM (9.5% vs. 0, P = 0.04). CO was independently associated with advanced fibrosis after adjusting for BMI and metabolic risk factors (aOR: 3.11 (1.10–8.96), P = 0.03). Among these 170 patients, 142 fulfilled metabolic dysfunction associated steatotic liver disease (MASLD) criteria. CO was also an independent risk factor for advanced fibrosis in MASLD (3.32 (1.23–8.5), P = 0.02).