Relationship Between Non-alcoholic Fatty Liver Disease and Decreased Bone Mineral Density: A Retrospective Cohort Study in Korea
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Objectives: The aim of this retrospective cohort study was to investigate whether non-alcoholic fatty liver disease (NAFLD) was associated with incident bone mineral density (BMD) decrease. Methods: This study included 4536 subjects with normal BMD at baseline. NAFLD was defined as the presence of fatty liver on abdominal ultrasonography without significant alcohol consumption or other causes. Decreased BMD was defined as a diagnosis of osteopenia, osteoporosis, or BMD below the expected range for the patient’s age based on dual-energy X-ray absorptiometry. Cox proportional hazards models were used to estimate the hazard ratio of incident BMD decrease in subjects with or without NAFLD. Subgroup analyses were conducted according to the relevant factors. Results: Across 13 354 person-years of total follow-up, decreased BMD was observed in 606 subjects, corresponding to an incidence of 45.4 cases per 1000 person-years (median follow-up duration, 2.1 years). In the model adjusted for age and sex, the hazard ratio was 0.65 (95% confidence interval, 0.51 to 0.82), and statistical significance disappeared after adjustment for body mass index (BMI) and cardiometabolic factors. In the subgroup analyses, NAFLD was associated with a lower risk of incident BMD decrease in females even after adjustment for confounders. The direction of the effect of NAFLD on the risk of BMD decrease changed depending on BMI category and body fat percentage, although the impact was statistically insignificant. Conclusions: NAFLD had a significant protective effect on BMD in females. However, the effects may vary depending on BMI category or body fat percentage.
Abstract
Objectives: The aim of this retrospective cohort study was to investigate whether non-alcoholic fatty liver disease (NAFLD) was associated with incident bone mineral density (BMD) decrease. Methods: This study included 4536 subjects with normal BMD at baseline. NAFLD was defined as the presence of fatty liver on abdominal ultrasonography without significant alcohol consumption or other causes. Decreased BMD was defined as a diagnosis of osteopenia, osteoporosis, or BMD below the expected range for the patient’s age based on dual-energy X-ray absorptiometry. Cox proportional hazards models were used to estimate the hazard ratio of incident BMD decrease in subjects with or without NAFLD. Subgroup analyses were conducted according to the relevant factors. Results: Across 13 354 person-years of total follow-up, decreased BMD was observed in 606 subjects, corresponding to an incidence of 45.4 cases per 1000 person-years (median follow-up duration, 2.1 years). In the model adjusted for age and sex, the hazard ratio was 0.65 (95% confidence interval, 0.51 to 0.82), and statistical significance disappeared after adjustment for body mass index (BMI) and cardiometabolic factors. In the subgroup analyses, NAFLD was associated with a lower risk of incident BMD decrease in females even after adjustment for confounders. The direction of the effect of NAFLD on the risk of BMD decrease changed depending on BMI category and body fat percentage, although the impact was statistically insignificant. Conclusions: NAFLD had a significant protective effect on BMD in females. However, the effects may vary depending on BMI category or body fat percentage.
참고문헌 (32)
- Prevention and management of osteoporosis: report of a WHO scientific group, "WHO Scientific Group on the Prevention and Management of Osteoporosis", ~ (2003)
- Kim YA, "Osteoporosis or low bone mass in adults aged 50 years old and above in Republic of Korea, 2008-2011", Public Health Wkly Rep, 7(42), pp.939~942 (2013)
- Ha YC, "Economic burden of osteoporosis in South Korea : claim data of the National Health Insurance Service from 2008 to 2011", Calcif Tissue Int, 101(6), pp.623~630 (2017)
- 정윤석, "골다공증의 최신 치료", 대한류마티스학회지, 19(1), pp.4~10 (2012), 대한류마티스학회
- 최중명, "비만관리와 과학적 근거", 대한의사협회지, 54(3), pp.250~265 (2011), 대한의사협회
- "Korea health statistics 2015: Korea National Health and Nutrition Examination Survey (KNHANES VI-3)"[URL]
- Global status report on noncommunicable diseases 2010, "World Health Organization", ~ (2010)
- Cao JJ, "Effects of obesity on bone metabolism", J Orthop Surg Res, 6, pp.30~ (2011)
- Zhao LJ, "Relationship of obesity with osteoporosis", J Clin Endocrinol Metab, 92(5), pp.1640~1646 (2007)
- Zhao LJ, "Correlation of obesity and osteoporosis : effect of fat mass on the determination of osteoporosis", J Bone Miner Res, 23(1), pp.17~29 (2008)
- Kim JH, "Fat mass is negatively associated with bone mineral content in Koreans", Osteoporos Int, 23(7), pp.2009~2016 (2012)
- Shapses SA, "Obesity is a concern for bone health with aging", Nutr Res, 39, pp.1~13 (2017)
- Walsh JS, "Obesity, type 2 diabetes and bone in adults", Calcif Tissue Int, 100(5), pp.528~535 (2017)
- Korean Association for the Study of the Liver (KASL), "KASL clinical practice guidelines: management of nonalcoholic fatty liver disease", Clin Mol Hepatol, 19(4), pp.325~348 (2013)
- Shulman GI, "Ectopic fat in insulin resistance, dyslipidemia, and cardiometabolic disease", N Engl J Med, 371(12), pp.1131~1141 (2014)
- Targher G, "Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease", N Engl J Med, 363(14), pp.1341~1350 (2010)
- Targher G, "Nonalcoholic fatty liver disease and decreased bone mineral density : is there a link", J Endocrinol Invest, 38(8), pp.817~825 (2015)
- Lee SH, "Association between bone mineral density and nonalcoholic fatty liver disease in Korean adults", J Endocrinol Invest, 39(11), pp.1329~1336 (2016)
- Moon SS, "Association of nonalcoholic fatty liver disease with low bone mass in postmenopausal women", Endocrine, 42(2), pp.423~429 (2012)
- Xia MF, "The association of liver fat content and serum alanine aminotransferase with bone mineral density in middle-aged and elderly Chinese men and postmenopausal women", J Transl Med, 14, pp.11~ (2016)
- Yang HJ, "Association of nonalcoholic fatty liver disease with bone mineral density and serum osteocalcin levels in Korean men", Eur J Gastroenterol Hepatol, 28(3), pp.338~344 (2016)
- Chen HJ, "Increased risk of osteoporosis in patients with nonalcoholic fatty liver disease: a population-based retrospective cohort study", Medicine (Baltimore), 97(42), pp.e12835~ (2018)
- Shen Z, "Increased risk of low bone mineral density in patients with non-alcoholic fatty liver disease : a cohort study", Eur J Endocrinol, 182(2), pp.157~164 (2020)
- "The Asia-Pacific perspective: redefining obesity and its treatment" (2000)[URL]
- Kim CW, "Sleep duration and quality in relation to non-alcoholic fatty liver disease in middle-aged workers and their spouses", J Hepatol, 59(2), pp.351~357 (2013)
- Cui R, "Low bone mineral density in Chinese adults with nonalcoholic fatty liver disease", Int J Endocrinol, 2013, pp.396545~ (2013)
- Kim G, "Significant liver fibrosis assessed using liver transient elastography is independently associated with low bone mineral density in patients with non-alcoholic fatty liver disease", PLoS One, 12(7), pp.e0182202~ (2017)
- Pardee PE, "Non-alcoholic fatty liver disease is associated with low bone mineral density in obese children", Aliment Pharmacol Ther, 35(2), pp.248~254 (2012)
- Poggiogalle E, "Non-alcoholic fatty liver disease connections with fat-free tissues : a focus on bone and skeletal muscle", World J Gastroenterol, 23(10), pp.1747~1757 (2017)
- 윤은영, "구간중도절단자료에서 생존함수와 중간생존시간에 대한 추정", 응용통계연구, 23(3), pp.521~531 (2010), 한국통계학회
- 박성환, "구간 중도절단 자료에서 Cox 비례위험모형의 추정방법 비교", 보건정보통계학회지, 40(3), pp.53~59 (2015), 한국보건정보통계학회
- Lee TC, "Comparison of imputation methods for interval censored time-to-event data in joint modelling of tree growth and mortality", Can J Stat, 39(3), pp.438~457 (2011)