High NAFLD fibrosis score in non-alcoholic fatty liver disease as a predictor of carotid plaque development: a retrospective cohort study based on regular health check-up data in China

Association of subclinical carotid artery atherosclerosis assessed by carotid ultrasound with nonalcoholic fatty liver disease fibrosis score in young and middle-aged men

BACKGROUND

Non-alcoholic Fatty Liver Disease (NAFLD) is a widespread liver disorder caused by excess fat accumulation in the liver with no significant alcohol consumption. This condition has been linked to the development of cardiovascular diseases (CVD) and atherosclerosis. Carotid intima-media thickness (CIMT) and carotid plaques, which are established markers of subclinical atherosclerosis, were used to assess CVD risk. However, few studies have explored the correlation between NAFLD and subclinical atherosclerosis, especially in young and middle-aged men. A study on 200 male patients aged 18-55 years aimed to investigate the association between NAFLD fibrosis score (NFS) and CIMT, as well as carotid plaque presence.

METHODS

The study, conducted between July 2023 and January 2024, included CIMT measurements and plaque assessments performed using B-mode ultrasound. Participants were divided into two groups based on CIMT values and plaque presence, and NFS was analyzed for its association with CIMT and plaque.

RESULTS

Participants with higher CIMT values had a significantly higher NFS (-2.9 ± 1.13 vs. -1.9 ± 1.4, P < 0.001) than those with lower CIMT values. Similarly, participants with carotid plaque also exhibited a higher NFS (-2.5 ± 1.3 vs. -1.7 ± 1.4, P = 0.002). Multivariate logistic regression analysis showed that NFS was a strong predictor of both increased CIMT (odds ratio [OR]: 1.564%95 CI 1.035-2.363; P = 0.034) and carotid plaque presence (OR: 1.605%95 CI 1.118-2.290; P = 0.010).

CONCLUSION

These results emphasize the potential role of NFS as a marker of subclinical atherosclerosis in young and middle-aged men.

A biological age model based on physical examination data to predict mortality in a Chinese population

Biological age could be reflective of an individual's health status and aging degree. Limited estimations of biological aging based on physical examination data in the Chinese population have been developed to quantify the rate of aging. We developed and validated a novel aging measure (Balanced-AGE) based on readily available physical health examination data. In this study, a repeated sub-sampling approach was applied to address the data imbalance issue, and this approach significantly improved the performance of biological age (Balanced-AGE) in predicting all-cause mortality with a 10-year time-dependent AUC of 0.908 for all-cause mortality. This mortality prediction tool was found to be effective across different subgroups by age, sex, smoking, and alcohol consumption status. Additionally, this study revealed that individuals who were underweight, smokers, or drinkers had a higher extent of age acceleration. The Balanced-AGE may serve as an effective and generally applicable tool for health assessment and management among the elderly population.

Development of a prediction model for predicting the prevalence of nonalcoholic fatty liver disease in Chinese nurses: the first-year follow data of a web-based ambispective cohort study

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is gradually becoming a huge threat to public health. With complex working characteristics, female nurses had been found with high risk of NAFLD. To develop and validate a prediction model to predict the prevalence of NAFLD based on demographic characteristics, work situation, daily lifestyle and laboratory tests in female nurses.

METHODS

This study was a part of the Chinese Nurse Cohort Study (The National Nurse Health Study, NNHS), and data were extracted from the first-year follow data collected from 1st June to 1st September 2021 by questionnaires and physical examination records in a comprehensive tertiary hospital. The questionnaires included demographic characteristics, work situation and daily lifestyle. Logistic regression and a nomogram were used to develop and validate the prediction model.

RESULTS

A total of 824 female nurses were included in this study. Living situation, smoking history, monthly night shift, daily sleep time, ALT/AST, FBG, TG, HDL-C, UA, BMI, TBil and Ca were independent risk factors for NAFLD occurance. A prediction model for predicting the prevalence of NAFLD among female nurses was developed and verified in this study.

CONCLUSION

Living situation, smoking history, monthly night shift, daily sleep time, ALT/AST, FBG, TG, UA, BMI and Ca were independent predictors, while HDL-C and Tbil were independent protective indicators of NAFLD occurance. The prediction model and nomogram could be applied to predict the prevalence of NAFLD among female nurses, which could be used in health improvement.

TRIAL REGISTRATION

This study was a part of the Chinese Nurse Cohort Study (The National Nurse Health Study, NNHS), which was a ambispective cohort study contained past data and registered at Clinicaltrials.gov ( https://clinicaltrials.gov/ct2/show/NCT04572347 ) and the China Cohort Consortium ( http://chinacohort.bjmu.edu.cn/project/102/ ).

Association of Circular RNAs levels in blood and Essential Hypertension with Carotid Plaque

BACKGROUND

As one of the essential hypertension (EH)-mediated target organ damage, carotid plaque is a crucial subclinical precursor for cardiovascular events. Therefore, it is vital to identify the risk factors and pathogenesis for EH with carotid plaque.

METHODS

Based on our previous microarray analysis, we selected four circRNAs as the candidate circRNAs and detected their expression levels in blood of 192 subjects (64 healthy controls, 64 EH patients, and 64 EH patients with carotid plaque) by qRT-PCR analysis. The regulatory mechanism of circRNAs involved in carotid plaque was predicted by bioinformatics analysis.

RESULTS

The level of hsa_circ_0124782 increased significantly and the levels of hsa_circ_0131618 and hsa_circ_0127342 decreased significantly in the EH group and EH with carotid plaque group compared with the control group (P < .05). Functional enrichment analysis showed that three circRNAs might be implicated in pathogenesis for carotid plaque.

CONCLUSION

Our study revealed the relationship between three circRNAs and carotid plaque, suggesting that they may serve as potential biomarkers for EH with carotid plaque.

The Association Between Non-Clinically Apparent Liver Fibrosis and Pulmonary Arterial Hypertension in Hispanic Patients

Background

Pulmonary arterial hypertension (PAH) is a deadly cardiopulmonary disease with multi-organ involvement including impaired liver function. Liver dysfunction in PAH is poorly understood but significantly associated with morbidity and mortality. Hispanics have a significantly higher prevalence of non-alcoholic fatty liver disease (NAFLD) and evidence of more advanced disease in comparison to other ethnic groups. The clinical impact of NAFLD in Hispanic PAH patients is unknown. We aimed to investigate the impact of a validated scoring system, non-alcoholic fatty liver disease fibrosis score (NFS), to predict the degree of liver fibrosis in a Hispanic PAH population and its relationship to hemodynamics, functional class, and outcomes.

Methods

A retrospective review of all treatment-naive Hispanic patients with group I World Health Organization (WHO) pulmonary hypertension (PH) at a single academic center between February 2016 and March 2021 was performed. Patients with history of substance or alcohol abuse, non-group I WHO PH, pre-existent liver disease, chronic kidney disease, atrial fibrillation, thyroid disease, and warfarin use were excluded from the study. The diagnosis of group I WHO PH was determined by cardiac catheterization after the exclusion of other etiologies. NFS was calculated for each patient and correlated with functional capacity, hemodynamics, N-terminal-pro-B-type natriuretic peptide (NT-proBNP), and survival.

Results

A total of 96 Hispanic patients were included in our study. The median age of patients in our cohort was 49 years (interquartile range: 15) and 69% of our cohort were females. Higher NFSs indicating advanced hepatic fibrosis (F3-F4) were found to correlate with elevated right-sided cardiac filling pressures (r = 0.27, P = 0.03), elevated levels of NT-proBNP (r = 0.32, P = 0.01), lower 6-minute walk distance (6MWD) (r = -0.49, P = 0.001), lower functional capacity (World Health Organization functional class, WHO-FC, r = -0.35, P = 0.051), a higher prevalence of diabetes (21.1% versus 51.9%, P = 0.001), a higher prevalence of risk factors for metabolic syndrome (81.5% versus 65.0%, P = 0.035), and worse 5-year survival rates.

Conclusion

In Hispanic patients with PAH, NFSs correlate with the degree of right-sided pressure overload. In addition, advanced NFSs were independently associated with lower 5-year survival rates and added prognostic information to other established risk parameters in PAH. This study suggests that screening for liver disease in this vulnerable patient population can aid in earlier detection leading to discussion of lifestyle modifications and possible escalation of PAH-targeted therapies, thus leading to potential improvement in survival rates.

Metabolic-associated fatty liver disease in relation to site-specific and multiple-site subclinical atherosclerosis

BACKGROUND & AIMS

Non-alcoholic fatty liver disease (NAFLD) and the newly proposed metabolic-associated fatty liver disease (MAFLD) were each associated with subclinical atherosclerosis. However, there is limited evidence on risk of atherosclerosis in individuals who meet the criteria for one but not the other. We aimed to investigate the associations of MAFLD or NAFLD status with site-specific and multiple-site atherosclerosis.

METHODS

This is a prospective cohort study involving 4524 adults within the MJ health check-up cohort. Logistic regression model was used to estimate odds ratios (ORs) and confidence intervals (CIs) for subclinical atherosclerosis (elevated carotid intima-media thickness [CIMT], carotid plaque [CP], coronary artery calcification [CAC] and retinal atherosclerosis [RA]) associated with MAFLD or NAFLD status, MAFLD subtypes and fibrosis status.

RESULTS

MAFLD was associated with higher risks of elevated CIMT, CP, CAC and RA (OR: 1.41 [95% CI 1.18-1.68], 1.23 [1.02-1.48], 1.60 [1.24-2.08], and 1.79 [1.28-2.52], respectively), whereas NAFLD per se did not increase risk of atherosclerosis except for elevated CIMT. Individuals who met both definitions or the definition for MAFLD but not NAFLD had higher risk of subclinical atherosclerosis. Among MAFLD subtypes, MAFLD with diabetes had the highest risk of subclinical atherosclerosis, but the associations did not differ by fibrosis status. Stronger positive associations were observed of MAFLD with multiple-site than single-site atherosclerosis.

CONCLUSIONS

In Chinese adults, MAFLD was associated with subclinical atherosclerosis, with stronger associations for multiple-site atherosclerosis. More attention should be paid to MAFLD with diabetes, and MAFLD might be a better predictor for atherosclerotic disease than NAFLD.

Subclinical and clinical atherosclerosis in non-alcoholic fatty liver disease is associated with the presence of hypertension

BACKGROUND AND AIMS

Non-alcoholic fatty liver disease (NAFLD) is associated with increased cardiovascular (CV) risk. However, it is unclear whether NAFLD contributes independently to the development of CV disease. Our study aimed at assessing the differences in several indices of atherosclerosis, arterial stiffness and cardiac morphology among patients with isolated NAFLD, isolated hypertension (HT) or a combination of the two conditions.

METHODS AND RESULTS

A total of 169 participants (mean age = 50.4 ± 10.2 yrs; males = 73.6%) were divided according to the presence of NAFLD and HT into three groups: only NAFLD (55 patients), only HT (49 patients), and NAFLD + HT (65 patients). Exclusion criteria were a BMI≥35 kg/m² and a diagnosis of diabetes mellitus. Carotid ultrasonography was performed to measure markers of atherosclerosis and arterial stiffness. Cardiac remodeling was analyzed using echocardiography. The prevalence of subclinical and overt atherosclerosis was significantly higher in the NAFLD + HT patients as compared to the other two groups (atherosclerotic plaques: 43.1%, 10.9%, and 22.4% (p < 0.001) in NAFLD + HT, NAFLD, and HT groups, respectively). No differences were found among indices of arterial stiffening and cardiac remodeling across the three groups. In multivariate regression analysis, the coexistence of NAFLD and HT was an independent risk factor for overt atherosclerosis (OR = 4.88, CI 95% 1.14-20.93), while no association was found when either NAFLD or HT was considered alone.

CONCLUSION

Overt atherosclerosis was significantly present only in NAFLD + HT patients, but not in patients with isolated NAFLD. This implies that the impact of NAFLD on vascular structure and function could depend on the coexistence of other major CV risk factors, such as HT.