Dose–response association of the ZJU index and fatty liver disease risk: A large cohort in China

Li, Xue; Qin, Pei; Lou, Yanmei; Zhao, Ping; Wang, Changyi; Ma, Jianping; Xu, Shan; Peng, Xiaolin; Chen, Hongen; Zhao, Dan; Hu, Fulan; Zhao, Yashuang

doi:10.1111/jgh.15286

Cited by 6 publications

(7 citation statements)

References 48 publications

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“…The estimated glomerular filtration rate (eGFR) was calculated by the Cockcroft-Gaulu equation: eGFR = [140-age (years)] × body weight (kg) × 1.23/Cr (μmol/L) (× 0.85 if female). The powerful surrogate marker for fatty liver disease, Zhejiang University (ZJU) index, was calculated by BMI (kg/m 2 ) + FBG (mmol/L)+ TG (mmol/L)+ 3 × ALT (U/L)/AST (U/L) (+2 if female) ( 25 ). The fibrosis-4 (FIB4) index was defined as: age (years) × AST (U/L)/(platelet count (10 9 /L) × √ ALT (U/L)] ( 26 ).…”

Section: Methodsmentioning

confidence: 99%

Plasma Homocysteine Level Is Independently Associated With Conventional Atherogenic Lipid Profile and Remnant Cholesterol in Adults

Zhou

Liu

et al. 2022

Front. Cardiovasc. Med.

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BackgroundHomocysteine (Hcy) is an independent risk factor for cardiovascular disease, while mechanisms are unclear. Despite inconsistent and limited, epidemiological and experimental studies indicated that hyperhomocysteinemia (HHcy) affected lipid metabolism. This study aims to investigate the association of plasma Hcy with traditional lipid profiles and remnant cholesterol (RC) in Chinese adults.MethodsIn total, 7,898 subjects aged 20–79 years who underwent a physical examination at Beijing Chao-Yang Hospital in Beijing were included in this study. Fasting plasma total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), lipoprotein (a) [Lp(a)], Hcy, and other metabolic risk factors were measured by routine automated laboratory methods. RC was calculated as TC minus HDL-C and LDL-C. The linear regression model and logistic regression model were used to assess the relationship between Hcy and lipids after adjusting potential confounders.ResultsOf the subjects, the median level of plasma Hcy was 13.0 μmol/L and 32.3% had HHcy. Plasma Hcy was negatively associated with HDL-C, ApoA1, and Lp(a) and positively associated with TG levels after adjusting age, sex, body mass index, blood pressure, alanine transaminase, aspartate transaminase, creatinine, uric acid, and glucose. HHcy significantly increased the risk of low HDL-C [odds ratio (OR) 1.26; 95%CI (1.11–1.44); p < 0.001]. The net mediation effects of ApoA1 on the relationship between Hcy and HDL-C before and after adjusting confounders were 46.9 and 30.6%, respectively. More interestingly, the RC level was significantly elevated in subjects with HHcy after adjusting other influencing factors (p = 0.025). Hcy presented a positive correlation with RC levels after adjusting the above confounding factors (β = 0.073, p = 0.004), and the correlation was still significant even after controlling other lipids, including TG, LDL-C, HDL-C, ApoA1, ApoB, and Lp(a).ConclusionOur study showed that plasma Hcy was not only significantly associated with conventional atherogenic lipids but also independently correlated with RC levels beyond other lipids after controlling potential confounders. This finding proposes that identifying Hcy-related dyslipidemia risk, both traditional lipids and RC residual risk, is clinically relevant as we usher in a new era of targeting Hcy-lowering therapies to fight against dyslipidemia or even cardiovascular disease.

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Section: Methodsmentioning

confidence: 99%

Plasma Homocysteine Level Is Independently Associated With Conventional Atherogenic Lipid Profile and Remnant Cholesterol in Adults

Zhou

Liu

et al. 2022

Front. Cardiovasc. Med.

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“…In another cohort involving 28,729 Chinese adults without fatty liver disease at baseline, the ZJU index was found to be significantly associated with an elevated risk of developing fatty liver disease over a median follow-up of 3.01 years. As the ZJU quartiles increased, the HRs increased correspondingly, with 4.87 (4.24-5.59) for women and 6.23 (5.56-6.98) men (12). Moreover, validation in North American settings was evident in a study involving 107 obese women, which revealed an AUC of 0.742 for the ZJU index, emphasizing its applicability in predicting NAFLD among this population (10).…”

Section: Discussionmentioning

confidence: 92%

“…Conversely, this interaction was not significant in the population under 50 years. In the research by Li et al (12), the findings revealed a higher HR for men, at 6.23 (5.56-6.98), compared to women, who had an HR of 4.87 (4. 24-5.59).…”

Section: Discussionmentioning

confidence: 92%

“…First proposed by Wang et al in a cross-sectional study involving 9,602 Chinese participants, the Zhejiang University (ZJU) Index proved to be a proficient tool for screening NAFLD (AUC=0.822) (9,10). Subsequent researches have confirmed the association between the ZJU index and the incidence of NAFLD in both Chinese and international populations, demonstrating superior predictive accuracy compared to the aforementioned indices (11,12). However, its efficacy in non-obese populations remains invalidated.…”

Section: Introductionmentioning

confidence: 99%

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Association between the ZJU index and risk of new-onset non-alcoholic fatty liver disease in non-obese participants: a Chinese longitudinal prospective cohort study

Zheng,

Yin,

Guo

et al. 2024

Front. Endocrinol.

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BackgroundNon-alcoholic fatty liver disease (NAFLD) is increasingly observed in non-obese individuals. The ZJU (Zhejiang University) index has been established as a new and efficient tool for detecting NAFLD, but the relationship between the ZJU index and NAFLD within non-obese individuals still remains unclear.MethodsA post-hoc evaluation was undertaken using data from a health assessment database by the Wenzhou Medical Center. The participants were divided into four groups based on the quartile of the ZJU Index. Cox proportional hazards regression, Kaplan-Meier analysis and tests for linear trends were used to evaluate the relationship between the ZJU index and NAFLD incidence. Subgroup analysis was conducted to test the consistency of the correlation between ZJU and NAFLD in subsgroups. Receiver operative characteristic (ROC) curve analysis was performed to evaluate the predictive performance of the ZJU index, compared with the Atherogenic index of plasma (AIP) and Remnant lipoprotein cholesterol (RLP-C) index.ResultsA total of 12,127 were included in this study, and 2,147 participants (17.7%) developed NAFLD in 5 years follow-up. Participants in higher ZJU quartiles tended to be female and have higher liver enzymes (including ALP, GGT, ALT, AST), GLU, TC, TG, LDL and higher NAFLD risk. Hazard Ratios (HR) and 95% confidence intervals (CI) for new-onset NAFLD in Q2, Q3, and Q4 were 3.67(2.43 to 5.55), 9.82(6.67 to 14.45), and 21.67(14.82 to 31.69) respectively in the fully adjusted model 3. With increased ZJU index, the cumulative new-onset NAFLD gradually increased. Significant linear associations were observed between the ZJU index and new-onset NAFLD (p for trend all<0.001). In the subgroup analysis, we noted a significant interaction in sex, with HRs of 3.27 (2.81, 3.80) in female and 2.41 (2.21, 2.63) in male (P for interaction<0.01). The ZJU index outperformed other indices with an area under the curve (AUC) of 0.823, followed by AIP (AUC=0.747) and RLP-C (AUC=0.668).ConclusionThe ZJU index emerges as a promising tool for predicting NAFLD risk in non-obese individuals, outperforming other existing parameters including AIP and RLP-C. This could potentially aid in early detection and intervention in this specific demographic.

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“…In both the derivation and validation cohorts, the AUROC of FFI was better than that of anthropometric parameters (BMI and WC) that are closely related to fatty liver disease and better than that of other NAFLD diagnosis scores (FLI, his, and ZJU) that have been proven to have good diagnostic value for NAFLD. [27][28][29] More studies are needed to assess noninvasive scoring models for MAFLD in the future.…”

Section: Discussionmentioning

confidence: 99%

Fasting serum fructose is associated with metabolic dysfunction‐associated fatty liver disease: A prospective study

Fan

Zhang

Chen

et al. 2023

Hepatology Research

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Aim The association between sugar‐sweetened beverages and metabolic disorders has been well studied. However, it has not been determined whether fasting serum fructose is associated with metabolic dysfunction‐associated fatty liver disease (MAFLD). Methods Participants were enrolled from 2011 to 2012 in Shanghai. Fasting serum fructose concentration was measured with a validated liquid chromatography–tandem mass spectrometry method. Results A total of 954 participants without diabetes were included. They were followed for an average of 3.5 years. A total of 320 (33.5%) participants had MAFLD at baseline. With the increase in fasting serum fructose level by quartile, the MAFLD prevalence was increased by 27.0%, 25.0%, 37.4%, and 44.5%, respectively (p < 0.001). Each SD increase in fasting serum fructose level was associated with a 60% increased risk of MAFLD (odds ratio 1.60; 95% confidence interval [CI], 1.36–1.88; p < 0.001). Fasting serum fructose levels were more closely associated with four components of MAFLD (hepatic steatosis, prediabetes, insulin resistance, and low high‐density lipoprotein). We built a diagnostic model named the fructose fat index (FFI). The area under the receiver operating characteristic curve of the FFI was 0.879 (95% CI, 0.850–0.908) in the derivation cohort and 0.827 (95% CI, 0.776–0.878) in the validation cohort. Subsequent prospective studies found that the incidence risk of MAFLD was 2.26 times higher in the high‐fructose group than in the low‐fructose group among female participants (95% CI, 1.46–3.49; p < 0.001). Conclusion Fasting serum fructose concentration, which mostly reflects endogenous fructose, was associated with a higher risk of MAFLD. The FFI derived from fasting serum fructose could be used to predict MAFLD.

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Dose–response association of the ZJU index and fatty liver disease risk: A large cohort in China

Cited by 6 publications

References 48 publications

Plasma Homocysteine Level Is Independently Associated With Conventional Atherogenic Lipid Profile and Remnant Cholesterol in Adults

Plasma Homocysteine Level Is Independently Associated With Conventional Atherogenic Lipid Profile and Remnant Cholesterol in Adults

Association between the ZJU index and risk of new-onset non-alcoholic fatty liver disease in non-obese participants: a Chinese longitudinal prospective cohort study

Fasting serum fructose is associated with metabolic dysfunction‐associated fatty liver disease: A prospective study

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