Fibrotic Burden Determines Cardiovascular Risk among Subjects with Metabolic Dysfunction-Associated Fatty Liver Disease
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Background/Aims: Metabolic dysfunction associated fatty liver disease (MAFLD) has recently been introduced to compensate for the conventional concept of nonalcoholic fatty liver disease (NAFLD). We explored whether fibrotic burden determines the risk of atherosclerotic cardiovascular disease (ASCVD) among subjects with MAFLD. Methods: We recruited 9,444 participants from the Korea National Health and Nutrition Examination Survey (2008 to 2011). Liver fibrosis was identified using the fibrosis-4 (FIB-4) index and NAFLD fibrosis score. The 10-year ASCVD risk score (>10%) was used to determine a high probability ASCVD risk. For sensitivity analysis, propensity score matching was assessed to subjects with aged 40 to 75 years free from ASCVD. Results: The prevalence of MAFLD was 38.0% (n=3,592). The ASCVD risk scores stratified in quartile were positively correlated to MAFLD and FIB-4 defined-significant liver fibrosis (p for trend <0.001). Individuals with both MAFLD and FIB-4 defined-significant liver fibrosis had a greater chance of high probability ASCVD risk (odds ratio [OR]=2.40; p<0.001) than those without MAFLD. The impact of MAFLD on high probability ASCVD risk was greater than that of significant liver fibrosis (OR=4.72 for MAFLD vs OR=1.88 for FIB-4 defined-significant liver fibrosis; all p<0.001). Among participants with MAFLD, low muscle mass enhanced the risk of significant liver fibrosis (OR=1.56 to 2.43; p<0.001). When NAFLD fibrosis score was applied to define significant liver fibrosis, similar findings were observed. Conclusions: Individuals with MAFLD had a substantial ASCVD risk compared to those without MAFLD. Accompanying significant liver fibrosis further enhanced the risk of ASCVD among subjects with MAFLD.
Abstract
Background/Aims: Metabolic dysfunction associated fatty liver disease (MAFLD) has recently been introduced to compensate for the conventional concept of nonalcoholic fatty liver disease (NAFLD). We explored whether fibrotic burden determines the risk of atherosclerotic cardiovascular disease (ASCVD) among subjects with MAFLD. Methods: We recruited 9,444 participants from the Korea National Health and Nutrition Examination Survey (2008 to 2011). Liver fibrosis was identified using the fibrosis-4 (FIB-4) index and NAFLD fibrosis score. The 10-year ASCVD risk score (>10%) was used to determine a high probability ASCVD risk. For sensitivity analysis, propensity score matching was assessed to subjects with aged 40 to 75 years free from ASCVD. Results: The prevalence of MAFLD was 38.0% (n=3,592). The ASCVD risk scores stratified in quartile were positively correlated to MAFLD and FIB-4 defined-significant liver fibrosis (p for trend <0.001). Individuals with both MAFLD and FIB-4 defined-significant liver fibrosis had a greater chance of high probability ASCVD risk (odds ratio [OR]=2.40; p<0.001) than those without MAFLD. The impact of MAFLD on high probability ASCVD risk was greater than that of significant liver fibrosis (OR=4.72 for MAFLD vs OR=1.88 for FIB-4 defined-significant liver fibrosis; all p<0.001). Among participants with MAFLD, low muscle mass enhanced the risk of significant liver fibrosis (OR=1.56 to 2.43; p<0.001). When NAFLD fibrosis score was applied to define significant liver fibrosis, similar findings were observed. Conclusions: Individuals with MAFLD had a substantial ASCVD risk compared to those without MAFLD. Accompanying significant liver fibrosis further enhanced the risk of ASCVD among subjects with MAFLD.
참고문헌 (25)
- Fan JG, "New trends on obesity and NAFLD in Asia", J Hepatol, 67, pp.862~873 (2017)
- Wong VW, "Asia-Pacific Working Party on Non-alcoholic Fatty Liver Disease guidelines 2017-Part 1 : definition, risk factors and assessment", J Gastroenterol Hepatol, 33, pp.70~85 (2018)
- Chitturi S, "The Asia-Pacific Working Party on Non-alcoholic Fatty Liver Disease guidelines 2017-Part 2 : management and special groups", J Gastroenterol Hepatol, 33, pp.86~98 (2018)
- Ekstedt M, "Long-term follow-up of patients with NAFLD and elevated liver enzymes", Hepatology, 44, pp.865~873 (2006)
- Han E, "Nonalcoholic fatty liver disease and sarcopenia are independently associated with cardiovascular risk", Am J Gastroenterol, 115, pp.584~595 (2020)
- Villanova N, "Endothelial dysfunction and cardiovascular risk profile in nonalcoholic fatty liver disease", Hepatology, 42, pp.473~480 (2005)
- Kim D, "Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States", Hepatology, 57, pp.1357~1365 (2013)
- You SC, "Hepatic fibrosis assessed using transient elastography independently associated with coronary artery calcification", J Gastroenterol Hepatol, 30, pp.1536~1542 (2015)
- Eslam M, "MAFLD : a consensus-driven proposed nomenclature for metabolic associated fatty liver disease", Gastroenterology, 158, pp.1999~2014 (2020)
- Eslam M, "A new definition for metabolic dysfunction-associated fatty liver disease : an international expert consensus statement", J Hepatol, 73, pp.202~209 (2020)
- Kweon S, "Data resource profile : the Korea National Health and Nutrition Examination Survey(KNHANES)", Int J Epidemiol, 43, pp.69~77 (2014)
- Bedogni G, "The fatty liver index : a simple and accurate predictor of hepatic steatosis in the general population", BMC Gastroenterol, 6, pp.33~ (2006)
- Vallet-Pichard A, "FIB-4 : an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest", Hepatology, 46, pp.32~36 (2007)
- Kotronen A, "Prediction of non-alcoholic fatty liver disease and liver fat using metabolic and genetic factors", Gastroenterology, 137, pp.865~872 (2009)
- Sumida Y, "Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholic fatty liver disease", nonalcoholic steatohepatitis, 2014, pp.20, 475~485
- GoffDC Jr, "2013 ACC", AHA guideline on the assessment of cardiovascular risk : a report of the American College of Cardiology, Circulation, pp.2014[DOI]
- Stone NJ, "Recent National Cholesterol Education Program Adult Treatment Panel III update : adjustments and options", Am J Cardiol, 96(4A), pp.53E~59E (2005)
- Levey AS, "A new equation to estimate glomerular filtration rate", Ann Intern Med, 150, pp.604~612 (2009)
- Studenski SA, "The FNIH sarcopenia project : rationale, study description, conference recommendations, and final estimates", J Gerontol A Biol Sci Med Sci, 69, pp.547~558 (2014)
- Francque SM, "Non-alcoholic fatty liver disease and cardiovascular risk : pathophysiological mechanisms and implications", J Hepatol, 65, pp.425~443 (2016)
- Musso G, "Association of liver disease with postprandial large intestinal triglyceriderich lipoprotein accumulation and pro", antioxidant imbalance in normolipidemic non-alcoholic steatohepatitis, 2008, pp.40, 383~394
- Wijarnpreecha K, "Associations between sarcopenia and nonalcoholic fatty liver disease and advanced fibrosis in the USA", Eur J Gastroenterol Hepatol, 31, pp.1121~1128 (2019)
- Lee YH, "Sarcopenia is associated with significant liver fibrosis independently of obesity and insulin resistance in nonalcoholic fatty liver disease : nationwide surveys(KNHANES 2008-2011)", Hepatology, 63, pp.776~786 (2016)
- Chia YC, "Validation of the pooled cohort risk score in an Asian population : a retrospective cohort study", BMC Cardiovasc Disord, 14, pp.163~ (2014)
- Vermeer SE, "Silent brain infarcts : a systematic review", Lancet Neurol, 6, pp.611~619 (2007)