Prevalence and Factors Associated with Nonalcoholic Fatty Liver Disease in a Nonobese Korean Population
2
조회
0
다운로드
6
인용
0
참고문헌
키워드
초록
Background/Aims: Nonalcoholic fatty liver disease (NAFLD) is an emerging problem in Asia, but little is known about the disease in the nonobese population. The aims of this study were to investigate the prevalence of NAFLD and the factors associated with it in a nonobese Korean population and to compare the clinical characteristics of nonobese and obese subjects with NAFLD. Methods: This cross-sectional study used data from 2,058 subjects who participated in a medical checkup program. Results: The prevalence of NAFLD was 12.4% (213/1,711) in the nonobese population. A higher body mass index (BMI), higher homeostasis model assessment of insulin resistance (HOMA-IR) values, higher alanine aminotransferase (ALT) levels, triglyceride concentrations ≥150 mg/dL, and hyperuricemia were independently associated with the presence of NAFLD in the nonobese subjects. Compared with the obese subjects with NAFLD, the nonobese subjects with NAFLD were composed of a higher proportion of females and had lower BMIs, smaller waist circumferences, lower HOMA-IR values, and fewer metabolic irregularities. Conclusions: Higher BMIs, HOMA-IR values, ALT levels, hypertriglyceridemia, and hyperuricemia were associated with NAFLD in the nonobese subjects. Clinicians should be particularly aware of the possibility of NAFLD in nonobese Asian people.
Abstract
Background/Aims: Nonalcoholic fatty liver disease (NAFLD) is an emerging problem in Asia, but little is known about the disease in the nonobese population. The aims of this study were to investigate the prevalence of NAFLD and the factors associated with it in a nonobese Korean population and to compare the clinical characteristics of nonobese and obese subjects with NAFLD. Methods: This cross-sectional study used data from 2,058 subjects who participated in a medical checkup program. Results: The prevalence of NAFLD was 12.4% (213/1,711) in the nonobese population. A higher body mass index (BMI), higher homeostasis model assessment of insulin resistance (HOMA-IR) values, higher alanine aminotransferase (ALT) levels, triglyceride concentrations ≥150 mg/dL, and hyperuricemia were independently associated with the presence of NAFLD in the nonobese subjects. Compared with the obese subjects with NAFLD, the nonobese subjects with NAFLD were composed of a higher proportion of females and had lower BMIs, smaller waist circumferences, lower HOMA-IR values, and fewer metabolic irregularities. Conclusions: Higher BMIs, HOMA-IR values, ALT levels, hypertriglyceridemia, and hyperuricemia were associated with NAFLD in the nonobese subjects. Clinicians should be particularly aware of the possibility of NAFLD in nonobese Asian people.
참고문헌 (47)
- Angulo P, "Nonalcoholic fatty liver disease", N Engl J Med, 346, pp.1221~1231 (2002)
- Kojima S, "Increase in the prevalence of fatty liver in Japan over the past 12 years: analysis of clinical background", J Gastroenterol, 38, pp.954~961 (2003)
- Neuschwander-Tetri BA, "Nonalcoholic steatohepatitis: summary of an AASLD Single Topic Conference", Hepatology, 37, pp.1202~1219 (2003)
- Farrell GC, "Guidelines for the assessment and management of non-alcoholic fatty liver disease in the Asia-Pacific region: executive summary", J Gastroenterol Hepatol, 22, pp.775~777 (2007)
- Das K, "Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease", Hepatology, 51, pp.1593~1602 (2010)
- Bellentani S, "Epidemiology of non-alcoholic fatty liver disease", Dig Dis, 28, pp.155~161 (2010)
- Browning JD, "Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity", Hepatology, 40, pp.1387~1395 (2004)
- Bedogni G, "Prevalence of and risk factors for nonalcoholic fatty liver disease : the Dionysos nutrition and liver study", Hepatology, 42, pp.44~52 (2005)
- Park SH, "Prevalence and risk factors of non-alcoholic fatty liver disease among Korean adults", J Gastroenterol Hepatol, 21, pp.138~143 (2006)
- Kim HJ, "Metabolic significance of nonalcoholic fatty liver disease in nonobese, nondiabetic adults", Arch Intern Med, 164, pp.2169~2175 (2004)
- Chen CH, "Prevalence and risk factors of nonalcoholic fatty liver disease in an adult population of Taiwan: metabolic significance of nonalcoholic fatty liver disease in nonobese adults", J Clin Gastroenterol, 40, pp.745~752 (2006)
- Matthews DR, "Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man", Diabetologia, 28, pp.412~419 (1985)
- Needleman L, "Sonography of diffuse benign liver disease: accuracy of pattern recognition and grading", AJR Am J Roentgenol, 146, pp.1011~1015 (1986)
- WHO Expert Consultation, "Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies", Lancet, 363, pp.157~163 (2004)
- Grundy SM, "Diagnosis and management of the metabolic syndrome: an American Heart Association", National Heart, Lung, and Blood Institute Scientific Statement, 2005, pp.112, 2735~2752
- Expert Panel on Detection, "Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)", JAMA, 285, pp.2486~2497 (2001)
- Sullivan GM, "Using effect size-or why the p value is not enough", J Grad Med Educ, 4, pp.279~282 (2012)
- Xu C, "Prevalence and risk factors for the development of nonalcoholic fatty liver disease in a nonobese Chinese population: the Zhejiang Zhenhai Study", Am J Gastroenterol, 108, pp.1299~1304 (2013)
- Kim NH, "Clinical and metabolic factors associated with development and regression of nonalcoholic fatty liver disease in nonobese subjects", Liver Int, 34, pp.604~611 (2014)
- Bhat G, "Insulin resistance and metabolic syndrome in nonobese Indian patients with non-alcoholic fatty liver disease", Trop Gastroenterol, 34, pp.18~24 (2013)
- Vendhan R, "Comparison of characteristics between nonobese and overweight", obese subjects with nonalcoholic fatty liver disease in a South Indian population, 2014, pp.16, 48~55
- Tsuneto A, "Fatty liver incidence and predictive variables", Hypertens Res, 33, pp.638~643 (2010)
- Cusi K, "Role of obesity and lipotoxicity in the development of nonalcoholic steatohepatitis: pathophysiology and clinical implications", Gastroenterology, 142, pp.711~725 (2012)
- Speliotes EK, "Fatty liver is associated with dyslipidemia and dysglycemia independent of visceral fat: the Framingham Heart Study", Hepatology, 51, pp.1979~1987 (2010)
- Sinn DH, "Ultrasonographically detected non-alcoholic fatty liver disease is an independent predictor for identifying patients with insulin resistance in non-obese, non-diabetic middle-aged Asian adults", Am J Gastroenterol, 107, pp.561~567 (2012)
- Li Y, "Association of serum uric acid level with non-alcoholic fatty liver disease: a cross-sectional study", J Hepatol, 50, pp.1029~1034 (2009)
- Jae Woong Lee, "Serum Uric Acid as a Predictor for the Development of Nonalcoholic Fatty Liver Disease in Apparently Healthy Subjects: A 5-Year Retrospective Cohort Study", Gut and Liver, 4(3), pp.378~383 (2010), 거트앤리버 발행위원회
- Xu C, "High serum uric acid increases the risk for nonalcoholic fatty liver disease: a prospective observational study", PLoS One, 5, pp.e11578~ (2010)
- 황인철, "The Relationship between Normal Serum Uric Acid and Nonalcoholic Fatty Liver Disease", Journal of Korean Medical Science, 26(3), pp.386~391 (2011), 대한의학회
- Liu PW, "Serum uric acid and metabolic syndrome in Taiwanese adults", Metabolism, 59, pp.802~807 (2010)
- Godsland IF, "A systematic evaluation of the insulin resistance syndrome as an independent risk factor for cardiovascular disease mortality and derivation of a clinical index", Metabolism, 60, pp.1442~1448 (2011)
- Albano E, "Review article : role of oxidative stress in the progression of non-alcoholic steatosis", Aliment Pharmacol Ther, 22(2), pp.71~73 (2005)
- Nieto FJ, "Uric acid and serum antioxidant capacity: a reaction to atherosclerosis?", Atherosclerosis, 148, pp.131~139 (2000)
- Waring WS, "Systemic uric acid administration increases serum antioxidant capacity in healthy volunteers", J Cardiovasc Pharmacol, 38, pp.365~371 (2001)
- Garcia-Ruiz I, "Uric acid and anti-TNF antibody improve mitochondrial dysfunction in ob", ob mice, 2006, pp.44, 581~591
- Hayden MR, "Uric acid: a new look at an old risk marker for cardiovascular disease, metabolic syndrome, and type 2 diabetes mellitus: the urate redox shuttle", Nutr Metab, 1, pp.10~ (2004)
- Suzuki I, "Allopurinol, an inhibitor of uric acid synthesis: can it be used for the treatment of metabolic syndrome and related disorders?", Drugs Today, 45, pp.363~378 (2009)
- Sanchez-Lozada LG, "Comparison of free fructose and glucose to sucrose in the ability to cause fatty liver", Eur J Nutr, 49, pp.1~9 (2010)
- Ratziu V, "Liver fibrosis in overweight patients", Gastroenterology, 118, pp.1117~1123 (2000)
- Sonsuz A, "Relationship between aminotransferase levels and histopathological findings in patients with nonalcoholic steatohepatitis", Am J Gastroenterol, 95, pp.1370~1371 (2000)
- Hsiao TJ, "Insulin resistance and ferritin as major determinants of nonalcoholic fatty liver disease in apparently healthy obese patients", Int J Obes Relat Metab Disord, 28, pp.167~172 (2004)
- Zelber-Sagi S, "NAFLD and hyperinsulinemia are major determinants of serum ferritin levels", J Hepatol, 46, pp.700~707 (2007)
- Nelson JE, "Relationship between the pattern of hepatic iron deposition and histological severity in nonalcoholic fatty liver disease", Hepatology, 53, pp.448~457 (2011)
- Imeryuz N, "Iron preloading aggravates nutritional steatohepatitis in rats by increasing apoptotic cell death", J Hepatol, 47, pp.851~859 (2007)
- Choi JS, "Effects of excess dietary iron and fat on glucose and lipid metabolism", J Nutr Biochem, 24, pp.1634~1644 (2013)
- Dongiovanni P, "Dietary iron overload induces visceral adipose tissue insulin resistance", Am J Pathol, 182, pp.2254~2263 (2013)
- Choi ES, "Association between serum irisin levels and non-alcoholic fatty liver disease in health screen examinees", PLoS One, 9, pp.e110680~ (2014)