Cardiac abnormalities in patients with nonalcoholic fatty liver disease : Insights from auxiliary examinations

Causal relationship analysis of MRI measurements of major human internal organs and liver disease

BACKGROUND

This study aimed to explore the causal association between imaging measurement indicators of major internal organs and liver lesions using a two-sample Mendelian randomization (MR) method.

METHODS

Data from the UK Biobank and GWAS Catalog platform were used to select single nucleotide polymorphisms (SNPs) associated with MRI or derived measurement results of various organ indicators as genetic instrumental variables. Data from the FinnGen project's R9 version were used to select liver lesion outcomes, such as nonalcoholic fatty liver disease (NAFLD), nonalcoholic cirrhosis, and primary hepatocellular carcinoma (HCC). UVMR analysis were utilized variable-by-variable, and MVMR was used to adjust for confounding on significant variables. Steiger directional test, heterogeneity, pleiotropy, and sensitivity tests were conducted to enhance reliability.

RESULTS

Univariate Mendelian randomization analysis (UVMR) indicated that liver volume (LV), liver fat (LF), and subcutaneous adipose tissue measurement (SATM) are risk factors for NAFLD. The multivariable MR (MVMR) results for NAFLD showed that LV and LF remained significant, while SATM did not. For cirrhosis (NAC), UVMR suggested that LV, LF, and SATM are risk factors, but MVMR results showed that only LV and LF remained significant. Additionally, pancreatic volume (PV) was found to be a protective factor, while splenic volume (SV) was a pathogenic factor for NAC. For HCC, both UVMR and MVMR analyses suggested that LF and liver iron (LI) are risk factors, while SATM did not remain significant in the MVMR analysis.

CONCLUSIONS

LV, LF, and SATM are associated with NAFLD. In the NAC stage, additional pathogenic effects of PV and SV were observed. The related results for LF and LI support the pathogenic effect of liver iron factors in the HCC stage.

Association of cardiovascular factors in diabetic patients with non-alcoholic fatty liver disease

PURPOSE

To evaluate the association between severity of hepatic steatosis/fibrosis with clinical, laboratory, and echocardiographic characteristics, including visceral obesity and type 2 diabetes mellitus (T2DM)-related micro- and macrovascular complications in diabetic patients with non-alcoholic fatty liver disease (NAFLD).

METHODS

We studied 60 consecutive NAFLD outpatients with T2DM, recording several demographic and clinical characteristics, trunk and visceral fat, cardiac ultrasound, and micro- and macrovascular complications of diabetes mellitus including microalbuminuria, diabetic peripheral neuropathy, peripheral vascular disease, and cardiac autonomic function. Severity of steatosis and fibrosis was evaluated with abdominal ultrasound and liver stiffness measurements, respectively.

RESULTS

Twenty-three (41%) of the patients had grade 1 steatosis and mean liver stiffness was 7.5 ± 3 kPa. After applying Bonferroni correction for multiple comparisons, ferritin concentration was the only factor significantly different between patients with mild (grade 1) compared to those with moderate/severe (grade 2/3) steatosis and showed good discriminative ability for the presence of moderate/severe steatosis (AUC: 0.74, sensitivity 88%, specificity 48%, PPV 74%, and NPV 72%). In addition, waist circumference was the only factor associated with the presence of significant fibrosis (≥ F2) with very good discriminative ability (AUC: 0.77, sensitivity 89%, specificity 45%, PPV 75%, and NPV 70%).

CONCLUSION

Specific clinical and laboratory characteristics, which may be determined via widely accessible and noninvasive techniques, were associated with severity of diabetics NAFLD, taking into account echocardiographic characteristics, visceral obesity, and T2DM-related systemic complications.

Nonalcoholic Fatty Liver Disease and Cardiovascular Disease: Overlapping Mechanisms

Nonalcoholic fatty liver disease (NAFLD) denotes a condition with excess fat in the liver. The prevalence of NAFLD is increasing, averaging > 25% of the Western population. In 25% of the patients, NAFLD progresses to its more severe form: nonalcoholic steatohepatitis and >25% of these progress to cirrhosis following activation of inflammatory and fibrotic processes. NAFLD is associated with obesity, type 2 diabetes, and the metabolic syndrome and represents a considerable and increasing health burden. In the near future, NAFLD cirrhosis is expected to be the most common cause for liver transplantation. NAFLD patients have an increased risk of developing cardiovascular disease as well as liver-related morbidity. In addition, hepatic steatosis itself appears to represent an independent cardiovascular risk factor. In the present review, we provide an overview of the overlapping mechanisms and prevalence of NAFLD and cardiovascular disease.

Association between nonalcoholic fatty liver and increased low-level albuminuria in postmenopausal women in China: A cross-sectional study

BACKGROUND

Several studies have suggested that nonalcoholic fatty liver disease (NAFLD) is associated with cardiovascular disease (CVD). The excretion of low-level albuminuria (LLA) elevates as the prevalence of CVD increases. However, few studies have explored the association between NAFLD and LLA.

METHODS

This cross-sectional study included 31 147 Chinese adults (7664 men and 23 483 women). The "normal" level of albuminuria as determined by the urinary albumin to creatinine ratio (UACR) was below 30 mg/g. LLA was defined as a higher level within the "normal" albuminuria range (5.54 mg/g < LLA≤29.9 mg/g). The participants with NAFLD were defined as having a fatty liver index (FLI) ≥ 60. The FLI was calculated using the Bedogni equation.

RESULTS

A positive association was found between UACR and FLI through multivariate linear regression analyses (nonstandardized β ± SE: .047 ± 0.004, P <.001). The logistic regression analyses revealed that NAFLD had adjusted odds ratios (ORs) showing a significant relationship with LLA in models 1 to 4 (all subjects: OR, 1.207; 95% CI, 1.098-1.326; women: OR, 1.43; 95% CI, 1.26-1.63; all P <.001); however, we did not find significant adjusted ORs among the men. In the stratified analyses, the relationship between NAFLD and LLA was significant among postmenopausal women with a body mass index ≥24 but <28 kg/m² , fasting plasma glucose ≥5.6 but <7.0 mmol/L, or postprandial plasma glucose ≥7.8 but <11.1 mmol/L and those aged below 60 years without moderate-intensity exercise.

CONCLUSIONS

A noteworthy association between NAFLD and LLA was found among postmenopausal women who had borderline blood glucose values, were overweight, and did not engage in moderate-intensity physical activity.