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Fu DF, Chen B. The relationship between the systemic immune inflammation index and the nonalcoholic fatty liver disease in American adolescents. BMC Gastroenterol 2024; 24:233. [PMID: 39044158 PMCID: PMC11267776 DOI: 10.1186/s12876-024-03324-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a growing health crisis in the general population of the United States (U.S.), but the relationship between systemic immune-inflammation (SII) index and NAFLD is not known. METHODS We collected data from the National Health and Nutrition Examination Survey 2017-2018. Next, propensity score matching (PSM), collinearity analysis, restricted cubic spline (RCS) plot, logistic regression, quantile regression analysis, subgroup analysis, mediation analysis, and population attributable fraction were used to explore the association of the SII with risk of NAFLD. RESULTS A total of 665 participants including the 532 Non-NAFLD and 133 NAFLD were enrolled for further analysis after PSM analysis. The RCS results indicated that there was a linear relationship between the SII and controlled attenuation parameter (p for nonlinear = 0.468), the relationship also existed after adjustment for covariates (p for nonlinear = 0.769). The logistic regression results indicated that a high SII level was an independent risk factor for NAFLD (OR = 3.505, 95% CI: 1.092-11.249, P < 0.05). The quantile regression indicated that at higher quantiles (0.90, and 0.95) the SII was significantly associated with NAFLD (p < 0.05). Mediation analysis indicated that alanine aminotransferase (ALT), triglycerides, and blood urea nitrogen (BUN) were partially contribute to the relationship between SII and NAFLD. The population attributable fractions indicated that 23.19% (95% CI: 8.22%, 38.17%) of NAFLD cases could be attributed to SII corresponding to 133 NAFLD cases. CONCLUSION There was a positive linear relationship between the SII and the risk of NAFLD. The ALT, triglycerides, and BUN had a partial mediating effect on the relationship between the SII and NAFLD.
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Affiliation(s)
- Dong-Fang Fu
- Department of Ultrasound, Hangzhou Xiaoshan First People's Hospital, No.199, Shixin South Road, Xiaoshan District, Hangzhou, Zhejiang, 311201, China
| | - Bin Chen
- Department of Ultrasound, Hangzhou Xiaoshan First People's Hospital, No.199, Shixin South Road, Xiaoshan District, Hangzhou, Zhejiang, 311201, China.
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Kaneva AM, Bojko ER. Fatty liver index (FLI): more than a marker of hepatic steatosis. J Physiol Biochem 2024; 80:11-26. [PMID: 37875710 DOI: 10.1007/s13105-023-00991-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023]
Abstract
Fatty liver index (FLI) was developed as a simple and accurate marker of hepatic steatosis. FLI is derived from an algorithm based on body mass index, waist circumference, and levels of triglycerides and gamma-glutamyltransferase, and it is widely used in clinical and epidemiological studies as a screening tool for discriminating between healthy and nonalcoholic fatty liver disease (NAFLD) subjects. However, a systematic review of the literature regarding FLI revealed that this index has more extensive relationships with biochemical and physiological parameters. FLI is associated with key parameters of lipid, protein and carbohydrate metabolism, hormones, vitamins and markers of inflammation, or oxidative stress. FLI can be a predictor or risk factor for a number of metabolic and nonmetabolic diseases and mortality. FLI is also used as an indicator for determining the effects of health-related prevention interventions, medications, and toxic substances on humans. Although in most cases, the exact mechanisms underlying these associations have not been fully elucidated, they are most often assumed to be mediated by insulin resistance, inflammation, and oxidative stress. Thus, FLI may be a promising marker of metabolic health due to its multiple associations with parameters of physiological and pathological processes. In this context, the present review summarizes the data from currently available literature on the associations between FLI and biochemical variables and physiological functions. We believe that this review will be of interest to researchers working in this area and can provide new perspectives and directions for future studies on FLI.
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Affiliation(s)
- Anastasiya M Kaneva
- Institute of Physiology of Кomi Science Centre of the Ural Branch of the Russian Academy of Sciences, FRC Komi SC UB RAS, 50 Pervomayskaya str., 167982, Syktyvkar, Russia.
| | - Evgeny R Bojko
- Institute of Physiology of Кomi Science Centre of the Ural Branch of the Russian Academy of Sciences, FRC Komi SC UB RAS, 50 Pervomayskaya str., 167982, Syktyvkar, Russia
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Wen W, Cai X, Zhu Q, Hu J, Hong J, Zhang X, Li N. Linear Relationship between Hepatic Steatosis Index and Major Adverse Cardiovascular Events in Hypertensive Patients with Obstructive Sleep Apnea: A Real-World Cohort Study from China. Rev Cardiovasc Med 2023; 24:280. [PMID: 39077567 PMCID: PMC11273115 DOI: 10.31083/j.rcm2410280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/28/2023] [Accepted: 05/15/2023] [Indexed: 07/31/2024] Open
Abstract
Background Hypertensive patients with obstructive sleep apnea (OSA) are at a high risk of cardiovascular disease (CVD), but assessments of CVD risk in this population are frequently constrained by the presence of comorbid medical conditions. The noninvasive and convenient hepatic steatosis index (HSI) can not only predict the degree of fatty liver degeneration but also correlates well with the severity of numerous diseases. However, the relationship between the HSI and CVD in hypertensive patients with OSA remains unclear. Methods This retrospective cohort study included patients aged ≥ 18 years with hypertension and a primary diagnosis of OSA and grouped them according to their baseline HSI. The primary outcome was new or recurrent major adverse cardiovascular and cerebrovascular events (MACCE), while the secondary outcomes were cardiac and cerebrovascular events. The relationship between the baseline HSI and the risk of endpoint events was evaluated using Kaplan-Meier curves, risk-factor graphs, and Cox regression models, while generalized additive models were used to identify linear relationships. The C-statistic, integrated discrimination improvement (IDI), and net reclassification index (NRI) were used to evaluate the predictive value of HSI increments for endpoint events. Results A total of 2467 participants were included in the analysis and separated into four groups (Q1-Q4) based on their HSI quartiles. Kaplan-Meier survival curves indicated that patients in the Q4 group had the lowest survival time. The Q4 group also showed a significantly higher risk of MACCE (HR [hazard ratio], 2.95; 95% CI [confidence interva]: 1.99-4.39; p < 0.001), cardiac events (HR, 2.80; 95% CI: 1.68-4.66; p < 0.001), and cerebrovascular events (HR, 3.21; 95% CI: 1.71-6.03; p < 0.001). The dose-response curve revealed a linear association between the HSI and the occurrence of endpoint events. For every unit increase in the HSI, the risks of MACCE, cardiac events, and cerebrovascular events increased by 43%, 38%, and 51%, respectively. The C-statistic, IDI, and NRI all indicated that the model including the HSI showed better discriminatory and classification efficacy for endpoint events in comparison with the conventional model (p < 0.05). Conclusions The HSI showed a linear relationship with the risk of MACCE in hypertensive OSA patients.
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Affiliation(s)
- Wen Wen
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute,
NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”,
Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, 830000 Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Xintian Cai
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute,
NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”,
Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, 830000 Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Qing Zhu
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute,
NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”,
Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, 830000 Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Junli Hu
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute,
NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”,
Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, 830000 Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Jing Hong
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute,
NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”,
Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, 830000 Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Xiangyang Zhang
- The First Affiliated Hospital of Xinjiang Medical University, 830000 Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Nanfang Li
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute,
NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”,
Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, 830000 Urumqi, Xinjiang Uygur Autonomous Region, China
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Yang Z, Han X, Wang K, Fang J, Wang Z, Liu G. Combined with multiplex and network analysis to reveal the key genes and mechanisms of nonalcoholic fatty liver disease. Int Immunopharmacol 2023; 123:110708. [PMID: 37523974 DOI: 10.1016/j.intimp.2023.110708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/05/2023] [Accepted: 07/23/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND AND AIMS Non-alcoholic fatty liver disease (NAFLD) has become a significant cause of chronic liver disease in developed countries, as a result of the worldwide trend of obesity and associated metabolic syndrome. Obesity and high-fat diet (HFD) are very common in patients with NAFLD. However, how to screen out key differentially expressed genes (DEGs) is a challenging task. The purpose of this study is to study the screen of key genes and pathways of HFD on the formation process of non-alcoholic fatty liver through network pharmacological analysis. METHODS In this study, 173 genes associated with NAFLD were collected from the Gene Expression Omnibus (GEO) database. To find significant genes and pathways, combine network clustering analysis, topology analysis, and pathway analysis. RESULTS The results showed that there were four key signaling pathways related to HFD, including complement cascade, Atorvastatin ADME, Asthma and Aflatoxin activation and detoxification. In addition, we identified six representative key genes, including Ccl5, Tlr2, Cd274, Cxcl10, Cxcl9 and Cd74, and screened three intersecting genes in Mus musculus and Homo sapiens sample, including C3, F2 and C7. CONCLUSIONS In conclusion, our study constructed the NAFLD gene regulatory network of C57BL/6J mice for the first time and jointly analyzed the Mus musculus samples and Homo sapiens samples. It provides new insights for identifying potential biomarkers and valuable therapeutic clues, and puts forward a new method for web-based research. These findings may provide potential targets for early diagnosis, effective therapy and prognostic markers of NAFLD.
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Affiliation(s)
- Zhao Yang
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha, Hunan 410128, China.
| | - Xuebing Han
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha, Hunan 410128, China.
| | - Keyu Wang
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha, Hunan 410128, China.
| | - Jun Fang
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha, Hunan 410128, China.
| | - Zheng Wang
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha, Hunan 410128, China.
| | - Gang Liu
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha, Hunan 410128, China.
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Abdelmawgood IA, Mahana NA, Badr AM, Mohamed AS, Al Shawoush AM, Atia T, Abdelrazak AE, Sakr HI. Echinochrome Ameliorates Physiological, Immunological, and Histopathological Alterations Induced by Ovalbumin in Asthmatic Mice by Modulating the Keap1/Nrf2 Signaling Pathway. Mar Drugs 2023; 21:455. [PMID: 37623736 PMCID: PMC10455754 DOI: 10.3390/md21080455] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
Asthma is a persistent inflammatory disease of the bronchi characterized by oxidative stress, airway remodeling, and inflammation. Echinochrome (Ech) is a dark-red pigment with antioxidant and anti-inflammatory activities. In this research, we aimed to investigate the effects of Ech against asthma-induced inflammation, oxidative stress, and histopathological alterations in the spleen, liver, and kidney in mice. Mice were divided into four groups (n = 8 for each): control, asthmatic, and asthmatic mice treated intraperitoneally with 0.1 and 1 mg/kg of Ech. In vitro, findings confirmed the antioxidant and anti-inflammatory activities of Ech. Ech showed antiasthmatic effects by lowering the serum levels of immunoglobulin E (IgE), interleukin 4 (IL-4), and interleukin 1β (IL-1β). It attenuated oxidative stress by lowering malondialdehyde (MDA) and nitric oxide (NO) contents and increasing reduced glutathione (GSH), superoxide dismutase (SOD), glutathione-s-transferase (GST), and catalase (CAT) in the liver, spleen, and kidney. Moreover, it protected asthma-induced kidney and liver functions by increasing total protein and albumin and decreasing aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, urea, and uric acid levels. Additionally, it ameliorated histopathological abnormalities in the lung, liver, spleen, and kidney. Additionally, molecular docking studies were used to examine the interactions between Ech and Kelch-like ECH-associated protein 1 (Keap1). PCR and Western blot analyses confirmed the association of Ech with Keap1 and, consequently, the regulatory role of Ech in the Keap1-(nuclear factor erythroid 2-related factor 2) Nrf2 signaling pathway in the liver, spleen, and kidney. According to our findings, Ech prevented asthma and its complications in the spleen, liver, and kidney. Inhibition of inflammation and oxidative stress are two of echinochrome's therapeutic actions in managing asthma by modulating the Keap1/Nrf2 signaling pathway.
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Affiliation(s)
| | - Noha Ahmed Mahana
- Zoology Department, Faculty of Science, Cairo University, Giza 12613, Egypt
| | - Abeer Mahmoud Badr
- Zoology Department, Faculty of Science, Cairo University, Giza 12613, Egypt
| | | | | | - Tarek Atia
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia;
| | - Amir Elhadi Abdelrazak
- Department of Medical Physiology, Medicine Program, Batterjee Medical College, Jeddah 21442, Saudi Arabia; (A.E.A.); (H.I.S.)
| | - Hader I. Sakr
- Department of Medical Physiology, Medicine Program, Batterjee Medical College, Jeddah 21442, Saudi Arabia; (A.E.A.); (H.I.S.)
- Department of Medical Physiology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
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Gau SY, Huang CH, Yang Y, Tsai TH, Huang KH, Lee CY. The association between non-alcoholic fatty liver disease and atopic dermatitis: a population-based cohort study. Front Immunol 2023; 14:1171804. [PMID: 37662939 PMCID: PMC10471967 DOI: 10.3389/fimmu.2023.1171804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/24/2023] [Indexed: 09/05/2023] Open
Abstract
Background In previous studies, it was reported that non-alcoholic fatty liver disease (NAFLD) incidence and prevalence increased in children with atopic dermatitis. Nevertheless, the actual association between the two diseases has not been fully proven in large-scale studies, and real-world evidence is missing. The objective of this nationwide, longitudinal cohort study was to evaluate the association between NAFLD and atopic dermatitis. Methods The National Health Insurance Research Database in Taiwan was utilized in this study. Patients with records of NAFLD diagnosis were recruited as the experimental group, and patients having less than three outpatient visits or one inpatient visiting record due to NAFLD were excluded from the study design. Non-NAFLD controls were matched based on a 1:4 propensity score matching. Potential confounders including age, gender, comorbidity, and medical utilization status were considered as covariates. The risk of future atopic dermatitis would be evaluated based on multivariate Cox proportional hazard regression. Results Compared with people without NAFLD, a decreased risk of atopic dermatitis in NALFD patients had been observed (aHR = 0.93, 95% CI 0.87-0.98). The trend was especially presented in young NAFLD patients. In patients younger than 40 years old, a 20% decreased risk of atopic dermatitis was reported (aHR = 0.80, 95% CI 0.70-0.92). Conclusion People with NAFLD were not associated with an increased risk of atopic dermatitis. Conversely, a 0.93-fold risk was noted in NAFLD patients, compared with NAFLD-free controls. Future studies are warranted to evaluate further the mechanism regarding the interplay between the inflammatory mechanisms of NAFLD and atopic dermatitis.
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Affiliation(s)
- Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ching-Hua Huang
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yih Yang
- Department of Obstetrics and Gynecology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Tung-Han Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Chien-Ying Lee
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan
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Peng H, Zhang J, Huang X, Xu M, Huang J, Wu Y, Peng XE. Development and validation of an online dynamic nomogram based on the atherogenic index of plasma to screen nonalcoholic fatty liver disease. Lipids Health Dis 2023; 22:44. [PMID: 36991386 DOI: 10.1186/s12944-023-01808-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD), a common liver disease worldwide, can be reversed early in life with lifestyle and medical interventions. This study aimed to develop a noninvasive tool to screen NAFLD accurately. METHODS Risk factors for NAFLD were identified using multivariate logistic regression analysis, and an online NAFLD screening nomogram was developed. The nomogram was compared with reported models (fatty liver index (FLI), atherogenic index of plasma (AIP), and hepatic steatosis index (HSI)). Nomogram performance was evaluated through internal and external validation (National Health and Nutrition Examination Survey (NHANES) database). RESULTS The nomogram was developed based on six variables. The diagnostic performance of the present nomogram for NAFLD (area under the receiver operator characteristic curve (AUROC): 0.863, 0.864, and 0.833, respectively) was superior to that of the HSI (AUROC: 0.835, 0.833, and 0.810, respectively) and AIP (AUROC: 0.782, 0.773, and 0.728, respectively) in the training, validation, and NHANES sets. Decision curve analysis and clinical impact curve analysis presented good clinical utility. CONCLUSION This study establishes a new online dynamic nomogram with excellent diagnostic and clinical performance. It has the potential to be a noninvasive and convenient method for screening individuals at high risk for NAFLD.
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Affiliation(s)
- Hewei Peng
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Xuefu North Road 1St, Shangjie Town, Minhou Country, Fuzhou, 350108, Fujian, China
| | - Junchao Zhang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Xuefu North Road 1St, Shangjie Town, Minhou Country, Fuzhou, 350108, Fujian, China
| | - Xianhua Huang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Xuefu North Road 1St, Shangjie Town, Minhou Country, Fuzhou, 350108, Fujian, China
| | - Miao Xu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Xuefu North Road 1St, Shangjie Town, Minhou Country, Fuzhou, 350108, Fujian, China
| | - Jingru Huang
- Grade 2022, Clinical Medicine Major, Integrated Chinese and Western medicine school, Fujian University of Traditional Chinese Medicine, 350108, Fuzhou, China
| | - Yunli Wu
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350108, China
| | - Xian-E Peng
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Xuefu North Road 1St, Shangjie Town, Minhou Country, Fuzhou, 350108, Fujian, China.
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350108, China.
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Kim N, Roh JH, Lee H, Kim D, Heo SJ. The impact of non-alcoholic fatty liver disease on sleep apnea in healthy adults: A nationwide study of Korea. PLoS One 2022; 17:e0271021. [PMID: 35857770 PMCID: PMC9299300 DOI: 10.1371/journal.pone.0271021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/21/2022] [Indexed: 02/01/2023] Open
Abstract
Background & aims Nonalcoholic fatty liver disease (NAFLD) is one of the most common health problems worldwide. Sleep apnea (SA) causes cardiovascular and metabolic problems, as well as a significant socioeconomic burden. Although several studies have found that SA causes NAFLD, there is no evidence that NAFLD causes SA. The goal of this study was to look at the relationship between NAFLD and SA in realworld data. Methods We evaluated 334,334 healthy individuals without comorbidities who underwent National Health checkups in the Republic of Korea from 2009 to 2014. NAFLD was defined by a surrogate marker, the fatty liver index (FLI). The association between FLI and SA was analyzed using multivariate Cox proportional hazards regression models. Results During a median followup of 5.3 years, 1,351 patients (0.4%) were newly diagnosed with SA. Subjects were categorized into quartile groups according to FLI (range: Q1, 0–4.9; Q2, 5.0–12.5; Q3, 12.6–31.0; Q4, >31.0). Subjects with higher FLIs had a significantly higher cumulative incidence of SA than those with lower FLIs (Q1, 119 [0.1%]; Q2, 210 [0.3%]; Q3, 339 [0.4%]; Q4, 683 [0.8%]; P < 0.001). Adjusted hazard ratios (HRs) revealed that a higher FLI was independently associated with an increased risk of SA (HR between Q4 and Q1, 4.03; 95% confidence interval, 3.22–5.05; P < 0.001). This association remained statistically significant after further adjustment for Body mass index (BMI) (HR between Q4 and Q1, 2.19; 95% confidence interval, 1.69–2.83; P < 0.001). FLI was significantly associated with an increased risk of new-onset SA regardless of baseline characteristics. Conclusion This study demonstrated that NAFLD, assessed by FLI, was independently associated with increased risk for SA in the healthy Korean population.
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Affiliation(s)
- Namkyun Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jae-Hyung Roh
- Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University Sejong Hospital, Chungnam National University, Sejong, Korea
| | - Hanbyul Lee
- Division of Healthcare Business Development, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Doyeon Kim
- Department of statistics, Kyungpook National University, Daegu, Korea
| | - Sung Jae Heo
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- * E-mail:
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