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Eto F, Nezu T, Aoki S, Kuzume D, Hosomi N, Maruyama H. Liver fibrosis index is associated with functional outcome among acute ischemic stroke patients. J Stroke Cerebrovasc Dis 2024; 33:107537. [PMID: 38157700 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107537] [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: 10/31/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION The fibrosis-4 (FIB-4) index and the fibrosis-5 (FIB-5) index are noninvasive markers of liver fibrosis in patients with nonalcoholic fatty liver disease. Although liver fibrosis a potential risk factor for stroke development, it is uncertain whether liver fibrosis influences stroke outcomes. We investigated the associations between these two indices and stroke patient outcomes and compared their predictive accuracy. METHODS We conducted a double-center, hospital-based, retrospective study. Consecutive acute ischemic stroke patients (n=2399) were analyzed. We calculated the FIB-4 index and the FIB-5 index and evaluated their relationships with poor stroke outcome, which was defined as a modified Rankin Scale score of 3-6 at three months after stroke. We evaluated the ability of each index to predict stroke outcome according to cutoff values calculated from receiver operating characteristic (ROC) curves. RESULTS Of 2399 recruited patients, 1549 patients (mean age, 73 years) were analyzed. The FIB-4 index and FIB-5 index had similar areas under their ROC curves for predicting stroke outcome (FIB-4 index, 0.675 and FIB-5 index, 0.683, P=0.334). The cutoff points of the FIB-4 index and FIB-5 index according to the ROC analysis were associated with poor stroke outcome in the multivariable analyses (odds ratio [OR] 2.23, 95 % confidence interval [CI] 1.72-2.89, OR 1.93, 95 % CI 1.47-2.54, respectively). CONCLUSIONS Liver fibrosis scores may be useful for predicting outcomes in patients with acute stroke. The FIB-4 and FIB-5 indices should be considered comprehensive tools for assessing the outcome risk after ischemic stroke.
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Affiliation(s)
- Futoshi Eto
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Daisuke Kuzume
- Department of Neurology, Chikamori Hospital, Kochi, Japan
| | - Naohisa Hosomi
- Department of Neurology, Chikamori Hospital, Kochi, Japan; Department of Disease Model, Research Institute of Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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2
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Obi MF, Reinberg Palmar A, Namireddy V, Campos FN, Cho HJ. The Liver-Heart Connection: A Literature Review of Liver Disease as a Risk Factor for Atrial Fibrillation. Cureus 2023; 15:e38536. [PMID: 37288203 PMCID: PMC10241719 DOI: 10.7759/cureus.38536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
Atrial fibrillation (AFib) is a common type of cardiac arrhythmia, characterized by disorganized atrial electrical activity with features of irregularly irregular heart rhythm and often with rapid ventricular response increasing the risk of stroke and heart failure due to tachyarrhythmia. The pathophysiology mechanism of AFib is either triggered by atrial distension, abnormality in conducting system, catecholamine excess, or increased atrial irritation or automaticity. Risk factors include uncontrolled diabetes, obesity, obstructive sleep apnea, hypothyroidism, and certain stimulants. Based on recent research, liver disease has recently been identified as a risk factor for AFib. Considering the progression of chronic liver disease, this literature review aims to investigate and summarize the relationship between liver disease and AFib and explore clinical interventions that can be utilized to prevent AFib aggravation.
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Affiliation(s)
- Mukosolu F Obi
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
| | | | | | | | - Hyun Joon Cho
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
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3
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Carbone RG, Puppo F. Atrial fibrillation and non-alcoholic fatty liver disease. Int J Cardiol 2023; 378:39. [PMID: 36841293 DOI: 10.1016/j.ijcard.2023.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/18/2023] [Indexed: 02/27/2023]
Affiliation(s)
| | - Francesco Puppo
- Department of Internal Medicine, University of Genoa, Genoa, Italy
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Wang Z, Wang Y, Luo F, Zhai Y, Li J, Chen Y, Li Q, Zhu L, Jiao S, Liu P, Zhou Y, Chen Y, Dong J, Sun Y. Impact of advanced liver fibrosis on atrial fibrillation recurrence after ablation in non-alcoholic fatty liver disease patients. Front Cardiovasc Med 2022; 9:960259. [PMID: 36277780 PMCID: PMC9583404 DOI: 10.3389/fcvm.2022.960259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Aim Advanced liver fibrosis is independently associated with new onset of atrial fibrillation (AF). Non-invasive liver fibrosis scores are considered an effective strategy for assessing liver fibrosis. This study aimed to investigate the association between advanced liver fibrosis and AF recurrence after ablation in patients with non-alcoholic fatty liver disease (NAFLD). Materials and methods A total of 345 AF patients with NAFLD who underwent de novo ablation between 2019 and 2020 at two large hospitals in China were included in this study. AF recurrence was defined as the occurrence of atrial arrhythmia for more than 30 s by electrocardiogram or 24 h Holter monitoring after the first 3 months of ablation. Predictive values of non-alcoholic fatty liver disease fibrosis score (NFS) and Fibrosis-4 (FIB-4) scores for AF burden and recurrence after ablation were assessed. Results At the 1 year follow-up after ablation, 38.8% of patients showed recurrence. Patients with recurrence who had higher FIB-4 and NFS scores were more likely to have persistent AF and a duration of AF ≥ 3 years. In Kaplan-Meier analysis, patients with intermediate and high NFS and FIB-4 risk categories had a higher risk of AF recurrence. Compared to patients with the low risk, intermediate and high NFS, and FIB-4 risk were independently associated with AF recurrence in multivariate Cox regression analysis (high risk: NFS, hazard ratio (HR): 3.11, 95% confidence interval (CI): 1.68∼5.76, p < 0.001; FIB-4, HR: 3.91, 95% CI: 2.19∼6.98, p < 0.001; intermediate risk: NFS, HR: 1.85, 95% CI: 1.10∼3.10, p = 0.020; FIB-4, HR: 2.08, 95% CI: 1.27∼3.41, p = 0.003). Conclusion NFS and FIB-4 scores for advanced liver fibrosis are associated with AF burden. Advanced liver fibrosis is independently associated with AF recurrence following ablation. Advanced liver fibrosis might be meaningful in risk classification for patients after AF ablation.
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Affiliation(s)
- Zhe Wang
- Department of Cardiology, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yijia Wang
- Department of Cardiology, Beijing Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fangyuan Luo
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yafei Zhai
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiaju Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yinong Chen
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Qing Li
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Longyang Zhu
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Siqi Jiao
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Peng Liu
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Yifeng Zhou
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Yingwei Chen
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,*Correspondence: Yingwei Chen,
| | - Jianzeng Dong
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,Department of Cardiology, Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yihong Sun
- Department of Cardiology, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China,Department of Cardiology, China-Japan Friendship Hospital, Beijing, China,Yihong Sun,
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5
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Martínez-Urbistondo D, de la Garza RG, Villares-Fernández P, Font C, Schellong S, López-Núñez JJ, Gil-Díaz A, Del Carmen Díaz-Pedroche M, Hirmerova J, Monreal M. Liver status and outcomes in patients without previous known liver disease receiving anticoagulant therapy for venous thromboembolism. Intern Emerg Med 2022; 17:725-734. [PMID: 34626318 PMCID: PMC8501936 DOI: 10.1007/s11739-021-02858-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/23/2021] [Indexed: 12/13/2022]
Abstract
The association between elevated liver enzymes or FIB-4 (fibrosis index 4) and outcome in patients with venous thromboembolism (VTE) has not been evaluated. Data from patients in RIETE (Registro Informatizado Enfermedad TromboEmbólica) were used to assess the association between elevated liver enzymes or FIB-4 levels and the rates of major bleeding or death in apparent liver disease-free patients with acute VTE under anticoagulation therapy. A total of 6206 patients with acute VTE and without liver disease were included. Of them, 92 patients had major bleeding and 168 died under anticoagulation therapy. On multivariable analysis, patients with elevated liver enzymes were at increased mortality risk (HR: 1.58; 95% CI: 1.10-2.28), while those with FIB-4 levels > 2.67 points were at increased risk for major bleeding (HR: 1.69; 95% CI: 1.04-2.74). Evaluation of liver enzymes and FIB-4 index at baseline in liver disease-free patients with VTE may provide additional information on the risk for major bleeding or death during anticoagulation.
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Affiliation(s)
| | - Rocío G de la Garza
- Internal Medicine Department, HM Sanchinarro, HM Hospitales, C/Oña 10, 28050, Madrid, Spain
| | | | - Carme Font
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
| | - Sebastian Schellong
- Department of Medical Clinic, Municipal Hospital of Dresden Friedrichstad, Dresden, Germany
| | - Juan José López-Núñez
- Department of Internal Medicine, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Aída Gil-Díaz
- Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, Spain
| | | | - Jana Hirmerova
- Department of Internal Medicine, University Hospital Plzen, Plzen, Czech Republic
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
- Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM-Universidad Católica San Antonio de Murcia, Murcia, Spain
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Mediterranean Diet: A Tool to Break the Relationship of Atrial Fibrillation with the Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease. Nutrients 2022; 14:nu14061260. [PMID: 35334916 PMCID: PMC8949975 DOI: 10.3390/nu14061260] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 12/15/2022] Open
Abstract
Atrial fibrillation (AF) is the most common supraventricular arrhythmia associated with increased cardiovascular and non-cardiovascular morbidity and mortality. As multiple factors may predispose the onset of AF, the prevention of the occurrence, recurrence and complications of this arrhythmia is still challenging. In particular, a high prevalence of cardio-metabolic comorbidities such as the metabolic syndrome (MetS) and in its hepatic manifestation, the non-alcoholic fatty liver disease (NAFLD), have been described in the AF population. A common pathogenetic mechanism linking AF, MetS and NAFLD is represented by oxidative stress. For this reason, in the past decades, numerous studies have investigated the effect of different foods/nutrients with antioxidant properties for the prevention of, and their therapeutic role is still unclear. In this narrative comprehensive review, we will summarize current evidence on (1) the association between AF, MetS and NAFLD (2) the antioxidant role of Mediterranean Diet and its components for the prevention of AF and (3) the effects of Mediterranean Diet on MetS components and NAFLD.
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Gutiérrez-Cuevas J, Santos A, Armendariz-Borunda J. Pathophysiological Molecular Mechanisms of Obesity: A Link between MAFLD and NASH with Cardiovascular Diseases. Int J Mol Sci 2021; 22:ijms222111629. [PMID: 34769060 PMCID: PMC8583943 DOI: 10.3390/ijms222111629] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
Obesity is now a worldwide epidemic ensuing an increase in comorbidities’ prevalence, such as insulin resistance, type 2 diabetes (T2D), metabolic dysfunction-associated fatty liver disease (MAFLD), nonalcoholic steatohepatitis (NASH), hypertension, cardiovascular disease (CVD), autoimmune diseases, and some cancers, CVD being one of the main causes of death in the world. Several studies provide evidence for an association between MAFLD and atherosclerosis and cardio-metabolic disorders, including CVDs such as coronary heart disease and stroke. Therefore, the combination of MAFLD/NASH is associated with vascular risk and CVD progression, but the underlying mechanisms linking MAFLD/NASH and CVD are still under investigation. Several underlying mechanisms may probably be involved, including hepatic/systemic insulin resistance, atherogenic dyslipidemia, hypertension, as well as pro-atherogenic, pro-coagulant, and pro-inflammatory mediators released from the steatotic/inflamed liver. MAFLD is strongly associated with insulin resistance, which is involved in its pathogenesis and progression to NASH. Insulin resistance is a major cardiovascular risk factor in subjects without diabetes. However, T2D has been considered the most common link between MAFLD/NASH and CVD. This review summarizes the evidence linking obesity with MAFLD, NASH, and CVD, considering the pathophysiological molecular mechanisms involved in these diseases. We also discuss the association of MAFLD and NASH with the development and progression of CVD, including structural and functional cardiac alterations, and pharmacological strategies to treat MAFLD/NASH and cardiovascular prevention.
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Affiliation(s)
- Jorge Gutiérrez-Cuevas
- Department of Molecular Biology and Genomics, Institute for Molecular Biology in Medicine and Gene Therapy, University of Guadalajara, CUCS, Guadalajara 44340, Jalisco, Mexico
- Correspondence: (J.G.-C.); (J.A.-B.); Tel.: +52-331-062-2083 (J.G.-C.); +52-333-677-8741 (J.A.-B.)
| | - Arturo Santos
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Campus Guadalajara, Zapopan 45201, Jalisco, Mexico;
| | - Juan Armendariz-Borunda
- Department of Molecular Biology and Genomics, Institute for Molecular Biology in Medicine and Gene Therapy, University of Guadalajara, CUCS, Guadalajara 44340, Jalisco, Mexico
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Campus Guadalajara, Zapopan 45201, Jalisco, Mexico;
- Correspondence: (J.G.-C.); (J.A.-B.); Tel.: +52-331-062-2083 (J.G.-C.); +52-333-677-8741 (J.A.-B.)
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8
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Association between Fasting Ketonuria and Advanced Liver Fibrosis in Non-Alcoholic Fatty Liver Disease Patients without Prediabetes and Diabetes Mellitus. Nutrients 2021; 13:nu13103400. [PMID: 34684404 PMCID: PMC8538175 DOI: 10.3390/nu13103400] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 12/13/2022] Open
Abstract
Ketone body production, an alternative fuel upon low glucose availability, reduces hepatic fat accumulation. However, its clinical implications have not been established in patients with nonalcoholic fatty liver disease (NAFLD). We investigated the association between spontaneous fasting ketonuria and liver fibrosis in patients with NAFLD without prediabetes and diabetes mellitus (DM). A total of 6202 patients with ultrasound confirmed NAFLD without prediabetes and DM were enrolled in the study. Using low cut off values of NAFLD fibrosis score (NFS) and fibrosis-4, liver fibrosis was defined as an intermediate-high probability of advanced liver fibrosis. Of the 6202 NAFLD patients, 360 (5.8%) had ketonuria. Compared to the patients without ketonuria, patients with ketonuria were younger (41.1 vs. 44.6 years, p < 0.001), had lower levels of glucose (87.2 vs. 91.0 mg/dL, p < 0.001), and homeostatic model assessment for insulin resistance (1.0 vs. 1.5, p < 0.001). The presence of ketonuria had an inverse association with liver fibrosis, assessed using both NFS (final adjusted odds ratio [aOR], 0.67; 95% confidence interval [CI], 0.45-1.01) and fibrosis-4 (aOR, 0.58; 95% CI, 0.40-0.84). The presence of ketonuria in NAFLD patients without prediabetes and DM may have favorable metabolic effects compared to the absence of ketonuria, independent of traditional metabolic factors.
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Luo Y, Wu B, Wu Y, Peng L, Li Z, Zhu J, Su Z, Liu J, Li S, Chong Y. Atrial fibrillation increases inpatient and 4-year all-cause mortality in critically ill patients with liver cirrhosis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1239. [PMID: 34532376 PMCID: PMC8421951 DOI: 10.21037/atm-21-3111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/22/2021] [Indexed: 12/18/2022]
Abstract
Background The association between atrial fibrillation (AF) and cirrhosis is unclear. Therefore, the aim of the present study was to determine the association between AF and short-term and 4-year mortality in critically ill patients with cirrhosis using a large database. Methods The Medical Information Mart for Intensive Care III (MIMIC III) database was used to identify patients with cirrhosis hospitalized in an intensive care unit from 2001 to 2012. Demographic and clinical data were extracted from the database. Clinical data and demographic information were collected for each patient in our study. Kaplan-Meier analysis and multivariate Cox regression models were performed to examine the relation between atrial fibrillation and in-hospital and 4-year all-cause mortality. Results A total of 1,481 patients (mean age: 58 years, 68% male) with liver cirrhosis were included in the analysis, and the prevalence of AF was 14.18%. The inpatient all-cause mortality rate was 26.6%, and patients who died in hospital had a significantly higher rate of AF (21.57% vs. 11.50%, P<0.001). Multivariate Cox regression analysis indicated that AF was significantly associated with inpatient all-cause mortality [hazard ratio (HR): 1.52, 95% confidence interval (CI): 1.19–1.95, P<0.001], and 4-year all-cause mortality (HR: 1.55, 95% CI: 1.12–2.13, P=0.008). Kaplan-Meier survival analysis showed that patients with AF had a significantly higher inpatient and 4-year all-cause mortality. Conclusions Critically ill patients with liver cirrhosis have a high rate of AF, and the presence of AF is an independent risk factor for inpatient and 4-year all-cause mortality.
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Affiliation(s)
- Yanting Luo
- Department of Cardiovascular Medicine, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bingyuan Wu
- Department of Cardiovascular Medicine, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuankai Wu
- Department of Infectious Diseases, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Long Peng
- Department of Cardiovascular Medicine, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zexiong Li
- Department of Cardiovascular Medicine, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jieming Zhu
- Department of Cardiovascular Medicine, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhongzhen Su
- Department of Ultrasound, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Jinlai Liu
- Department of Cardiovascular Medicine, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Suhua Li
- Department of Cardiovascular Medicine, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yutian Chong
- Department of Infectious Diseases, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Kang MK, Baek JH, Kweon YO, Tak WY, Jang SY, Lee YR, Hur K, Kim G, Lee HW, Han MH, Choi JH, Park SY, Park JG. Association of Skeletal Muscle and Adipose Tissue Distribution with Histologic Severity of Non-Alcoholic Fatty Liver. Diagnostics (Basel) 2021; 11:diagnostics11061061. [PMID: 34207587 PMCID: PMC8227703 DOI: 10.3390/diagnostics11061061] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/18/2022] Open
Abstract
Adipose tissue and skeletal muscle is associated with non-alcoholic fatty liver disease (NAFLD). This study evaluates the association between body composition and histologic severity in patients with NAFLD. Using the cross-sectional CT images at the level of L3 vertebra and the histologic findings of 178 patients with biopsy-proven NAFLD, we analyzed the correlation of the histologic findings to the skeletal muscle index (SMI), subcutaneous adipose tissue index (SATI), and visceral adipose tissue index (VATI), which is defined as the body composition area (cm2) by height squared (m2). The clinical and laboratory features with body composition were analyzed to determine the risk factors for advanced fibrosis. The VATI significantly increased in severe non-alcoholic steatohepatitis (NASH) or advanced fibrosis. In addition, the VATI was correlated with the NAFLD activity score (NAS) and the fibrosis stage. In multivariate analyses, age (odds ratio (OR), 1.09; 95% confidence interval (CI), 1.02–1.19; p = 0.025), severe NASH (OR, 8.66; 95% CI, 2.13–46.40; p = 0.005), and visceral adiposity (OR, 6.77; 95% CI, 1.81–29.90; p = 0.007) were independently associated with advanced fibrosis in patients with NAFLD. Visceral adiposity is correlated with the histologic severity of NAFLD, which is independently associated with advanced fibrosis.
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Affiliation(s)
- Min-Kyu Kang
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea; (M.-K.K.); (J.-H.B.)
| | - Jung-Hun Baek
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea; (M.-K.K.); (J.-H.B.)
| | - Young-Oh Kweon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (Y.-O.K.); (W.-Y.T.); (S.-Y.J.); (Y.-R.L.)
| | - Won-Young Tak
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (Y.-O.K.); (W.-Y.T.); (S.-Y.J.); (Y.-R.L.)
| | - Se-Young Jang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (Y.-O.K.); (W.-Y.T.); (S.-Y.J.); (Y.-R.L.)
| | - Yu-Rim Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (Y.-O.K.); (W.-Y.T.); (S.-Y.J.); (Y.-R.L.)
| | - Keun Hur
- Department of Biochemistry and Cell Biology, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (K.H.); (G.K.)
| | - Gyeonghwa Kim
- Department of Biochemistry and Cell Biology, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (K.H.); (G.K.)
| | - Hye-Won Lee
- Department of Pathology, School of Medicine, Keimyung University Dongsan Hospital, Daegu 42601, Korea;
| | - Man-Hoon Han
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea;
| | - Joon-Hyuk Choi
- Department of Pathology, College of Medicine, Yeungnam University, Daegu 42415, Korea;
| | - Soo-Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (Y.-O.K.); (W.-Y.T.); (S.-Y.J.); (Y.-R.L.)
- Correspondence: (S.-Y.P.); (J.-G.P.); Tel.: +82-53-200-5516 or +82-9205-3619 (S.-Y.P.); +82-53-620-3837 or +82-10-2957-1798 (J.-G.P.); Fax: +82-53-426-8773 (S.-Y.P.); +82-53-654-8386 (J.-G.P.)
| | - Jung-Gil Park
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea; (M.-K.K.); (J.-H.B.)
- Correspondence: (S.-Y.P.); (J.-G.P.); Tel.: +82-53-200-5516 or +82-9205-3619 (S.-Y.P.); +82-53-620-3837 or +82-10-2957-1798 (J.-G.P.); Fax: +82-53-426-8773 (S.-Y.P.); +82-53-654-8386 (J.-G.P.)
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11
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Kang MK, Park JG. Low Skeletal Muscle Mass Is a Risk Factor for Subclinical Atherosclerosis in Patients with Nonalcoholic Fatty Liver Disease. Diagnostics (Basel) 2021; 11:diagnostics11050854. [PMID: 34068776 PMCID: PMC8150334 DOI: 10.3390/diagnostics11050854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 12/12/2022] Open
Abstract
Sarcopenia and nonalcoholic fatty liver disease (NAFLD) are associated with subclinical atherosclerosis. We aimed to investigate the association between low skeletal muscle mass (LSMM) and subclinical atherosclerosis in patients with NAFLD. A total of 683 patients with ultrasound-confirmed NAFLD who underwent carotid ultrasonography were enrolled retrospectively. The appendicular skeletal muscle mass divided by the body mass index was used to define LSMM. Using carotid ultrasound, increased carotid intima–media thickness (cIMT, >1 mm) and the presence of carotid plaques were measured. Of the 683 patients, 75 (11.0%) had LSMM. In multivariate analyses, LSMM was associated with increased cIMT (odds ratios (ORs) = 2.26 to 2.95, all p < 0.05) and carotid plaques (ORs = 2.05 to 2.90, all p < 0.05). The proportion of increased cIMT and carotid plaques was significantly higher in obese NAFLD patients with LSMM than in those without LSMM (33.3% vs. 17.6% for cIMT and 12.7% vs. 5.7% for carotid plaques, respectively; p < 0.001). Furthermore, LSMM was independently associated with increased cIMT (ORs = 2.44 to 3.30, all p < 0.05) and carotid plaques (ORs = 2.56 to 3.54, all p < 0.05) in obese NAFLD patients. LSMM is associated with subclinical atherosclerosis in patients with NAFLD.
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Affiliation(s)
- Min-Kyu Kang
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea;
| | - Jung-Gil Park
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea;
- Correspondence: ; Tel.: +82-53-620-3835 or +82-10-2957-1798; Fax: +82-53-654-8386
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