Alcoholic and non-alcoholic fatty liver disease and associations with coronary artery calcification: evidence from the Kangbuk Samsung Health Study

Chang, Yoosoo; Ryu, Seungho; Sung, Ki‐Chul; Cho, Yong Kyun; Sung, Eunju; Kim, Hanna; Jung, Hyun Suk; Yun, Kyung Eun; Ahn, Joong Kyong; Shin, Hocheol; Wild, Sarah H.; Byrne, Christopher D.

doi:10.1136/gutjnl-2018-317666

Cited by 138 publications

(139 citation statements)

References 38 publications

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“…The mechanisms underlying the deleterious effects of NAFLD on CVD outcomes are not clear. Insulin resistance, oxidative stress, altered lipoprotein metabolism and adipokine levels, and chronic inflammation have been shown to be associated with the development of accelerated atherosclerosis in patients with NAFLD 5,32,38,47 . Further research is needed to unveil more specific mechanisms by which NAFLD may contribute to the development and progression of atherosclerosis 21 .…”

Section: Discussionmentioning

confidence: 99%

Association between non-alcoholic fatty liver disease and coronary calcification depending on sex and obesity

Kim

Park

Lee

et al. 2020

Sci Rep

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Non-alcoholic fatty liver disease (NAFLD) is considered a hepatic manifestation of metabolic syndrome and is associated with cardiovascular outcomes. We investigated whether NAFLD was associated with coronary artery calcification (CAC) in participants without a previous history of cardiovascular disease and whether this association differed according to sex and obesity status after adjustment for other atherosclerosis risk factors, alcohol intake, and liver enzyme levels. Among 67,441 participants, data from 8,705 participants who underwent a fatty liver status and CAC assessment during routine health screening were analysed. CAC scores were calculated using computed tomography. NAFLD was diagnosed in patients with evidence of liver steatosis on ultrasonography. Obesity was defined as a body mass index of ≥25 kg/m 2. Multivariate analysis showed a significant association between NAFLD and CAC in non-obese participants (odds ratio, 1.24 [95% confidence interval, 1.01-1.53]), whereas NAFLD and CAC were not associated in obese participants. Interaction analysis showed that the association between NAFLD and CAC was influenced by sex and obesity. Subgroup analysis revealed a significant association between NAFLD and CAC in non-obese male participants (odds ratio, 1.36 [1.07-1.75]), but not in female participants. Our study indicates that non-obese men with NAFLD are prone to CAC. Cardiovascular disease (CVD) is a major cause of death, and its contribution to the overall disease burden is expected to increase. Therefore, there have been worldwide efforts to identify cardiovascular risk factors 1,2. Obesity is a well-established risk factor for CVD and mortality 3 ; however, recent studies have reported the localized distribution of body fat rather than overall obesity 4,5. In one study, regional fat distribution was shown to have a significant association with the risk of coronary heart disease after adjusting for body mass index (BMI) 4. Non-alcoholic fatty liver disease (NAFLD) can progress to liver cirrhosis and liver cancer, but its clinical manifestation is not confined to the liver. Moreover, it has been associated with an increased prevalence and incidence of CVD 6-8. NAFLD is a highly prevalent metabolic abnormality closely linked to the overweight and obesity epidemic 8-10. In tertiary liver centres, a majority of patients with NAFLD also have an increased BMI, but approximately 1 out of 8 NAFLD patients has normal BMI 11. Globally, the prevalence of NAFLD in the non-obese population has been widely reported, ranging from 3% to 30% 12. Coronary artery calcification (CAC) is a non-invasive predictor of the burden of coronary atherosclerosis and is evaluated using computed tomography (CT). CAC scores have been reported to be associated with increased

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Section: Discussionmentioning

confidence: 99%

Association between non-alcoholic fatty liver disease and coronary calcification depending on sex and obesity

Kim

Park

Lee

et al. 2020

Sci Rep

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“…This study had several advantages: (1) It was based on a national population, providing a large sample size, (2) We used ultrasonography, a widely available, noninvasive and recommended method for the diagnosis of liver steatosis (32), to diagnose NAFLD, especially in large population-based studies (33)(34)(35), while some early population-based studies used non-invasive fatty liver models (12,36). The major limitation of this study is that it is only a cross-sectional study.…”

Section: Discussionmentioning

confidence: 99%

Association between Vitamin D Status and Non-Alcoholic Fatty Liver Disease: A Population-Based Study

Liu

Wan

et al. 2019

J Nutr Sci Vitaminol

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The relationship between vitamin D levels and non-alcoholic fatty liver disease (NAFLD) remains unestablished. In this study, we aimed to explore the relationship between vitamin D levels and NAFLD based on population survey data. This cross-sectional study was conducted based on data from the National Health and Nutrition Examination Survey. Liver steatosis was diagnosed by ultrasonography. Binary logistic regression analyses were performed to determine the relationship between vitamin D status and NAFLD. A total of 9,782 participants were identified in this analysis, with 46.8% male and an average age of 44.4160.16 y old. Among them, 6,047 (61.8%) cases were without NAFLD, 1,357 (13.9%) had mild NAFLD, 1,594 (16.3%) had moderate and 784 (8.0%) had severe NAFLD. Compared to those with non-NAFLD or mild NAFLD, patients in the moderate to severe NAFLD group had higher vitamin D deficiency or insufficiency rates (12.4% vs 11.5% and 36.8% vs 33.2%, respectively). After adjustment for male gender, older age, race, BMI, history of diabetes and vitamin D intake, vitamin D levels were independently associated with the severity of NAFLD (vitamin D deficiency group OR: 1.314, 95% CI: 1.129 to 1.529, vitamin D insufficiency group OR: 1.203, 95% CI: 1.090 to 1.328). Besides that, cold season was also found to be an independent factor for NAFLD (OR: 0.896, 95% CI: 0.820 to 0.979). Lower vitamin D level is an independent risk factor for NAFLD. Vitamin D levels are inversely associated with the severity of NAFLD. Cold season increases the risk of NAFLD independently.

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“…Ultrasonographic diagnosis of fatty liver was defined as the presence of a diffuse increase of fine echoes in the liver parenchyma compared with the kidney or spleen parenchyma. [,] Inter‐ and intra‐observer reliability for fatty liver diagnosis, measured in the year 2013, was substantial (kappa statistic of 0.74) and excellent (kappa statistic of 0.94), respectively . Severity of hepatic steatosis on ultrasound was also recorded as (a) mild (diffusely increased hepatic echogenicity without obscuring intrahepatic vessels and diaphragmatic echogenicity), (b) moderate (diffusely increased hepatic echogenicity obscuring intrahepatic vessels but without obscuring diaphragmatic echogenicity) and (c) severe steatosis (diffusely increased hepatic echogenicity obscuring intrahepatic vessels as well as diaphragmatic echogenicity) Liver with any degree of fat accumulation was considered fatty liver in the present study.…”

Section: Methodsmentioning

confidence: 99%

Metabolically healthy versus unhealthy obesity and risk of fibrosis progression in non‐alcoholic fatty liver disease

Kim

Chang

Cho

et al. 2019

Liver International

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Background & Aims Little is known about the impact of metabolically healthy obesity on fibrosis progression in non‐alcoholic fatty liver disease (NAFLD). We investigated the association of body mass index (BMI) category, body fat percentage and waist circumference with worsening of noninvasive fibrosis markers in metabolically healthy and unhealthy individuals with NAFLD. Methods A cohort study was performed on 59 957 Korean adults with NAFLD (13 285 metabolically healthy and 46 672 metabolically unhealthy individuals) who were followed for a median of 7.7 years. Being metabolically healthy was defined as not having any metabolic syndrome component and having a homoeostasis model assessment of insulin resistance <2.5. Progression from low to intermediate or high probability of advanced fibrosis was assessed using the NAFLD fibrosis score (NFS). Results During 339 253.1 person‐years of follow‐up, 9857 subjects with low NFS at baseline progressed to intermediate or high NFS. Among metabolically healthy individuals, the multivariable‐adjusted HRs (95% CI) for NFS worsening comparing BMIs 23‐24.9, 25‐29.9 and ≥30 with a BMI of 18.5‐22.9 kg/m2 were 1.19 (1.00‐1.42), 1.79 (1.52‐2.10) and 3.52 (2.64‐4.69), respectively, whereas the corresponding HRs (95% CI) in metabolically unhealthy individuals were 1.37 (1.24‐1.52), 2.18 (1.99‐2.39) and 4.26 (3.83‐4.75). A similar trend was observed in the analyses using body fat and waist circumference. Conclusion In the large‐scale cohort of young and middle‐aged individuals with NAFLD, BMI was positively associated with worsening of noninvasive fibrosis marker regardless of metabolic health status. Excess adiposity per se, even without accompanying metabolic health status, may contribute to fibrosis progression in NAFLD.

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Alcoholic and non-alcoholic fatty liver disease and associations with coronary artery calcification: evidence from the Kangbuk Samsung Health Study

Cited by 138 publications

References 38 publications

Association between non-alcoholic fatty liver disease and coronary calcification depending on sex and obesity

Association between non-alcoholic fatty liver disease and coronary calcification depending on sex and obesity

Association between Vitamin D Status and Non-Alcoholic Fatty Liver Disease: A Population-Based Study

Metabolically healthy versus unhealthy obesity and risk of fibrosis progression in non‐alcoholic fatty liver disease

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