Mean Arterial Pressure Is Related to Incident Nonalcoholic Fatty Liver Disease among the Nonobese Female with Normal Low-Density Lipoprotein Cholesterol Levels: A Large Cohort Study in China

Abstract

Aim. We aimed to demonstrate the independent effect of mean arterial pressure (MAP) on incident nonalcoholic fatty liver disease (NAFLD) among the nonobese Chinese with normal low-density lipoprotein cholesterol (LDL-C) levels. Methods. 16,153 nonobese participants without NAFLD at baseline were enrolled and then assigned to four groups by quartiles of MAP (Q1-Q4). A subgroup analysis by gender was also conducted. Participants were diagnosed with NAFLD by ultrasonography. Results. During a mean follow-up of 2.80 years, the cumulative incidence of NAFLD was 14.37 and the incidence rate was 513.17 per 10,000 person-years. The cumulative incidence of NAFLD for the whole population or gender groups gradually increased with the quartiles of MAP (all P<0.001). In the Q4 of MAP, the cumulative incidence of NAFLD for the whole population, male, and female reached up to 6.22 (5.75-6.70), 6.70 (6.21-7.19), and 5.69 (5.24-6.14), respectively. After adjustment for potential confounders, as compared with Q1, the hazard ratio for NAFLD was 1.328 (1.072-1.647), 1.625 (1.276-2.069), and 1.697 (1.231-2.340) for Q2, Q3, and Q4, respectively. In subgroup analysis, the respective hazard ratio for NAFLD in Q2, Q3, and Q4 of MAP was 1.760 (1.276-2.429), 2.080 (1.433-3.019), and 2.377 (1.452-3.890), compared with female in the Q1 of MAP. But MAP was not associated with incident NAFLD in male. Besides, MAP had a larger area under the receiver-operating characteristic curves than SBP or DBP, with optimal cutoff point of 88 mmHg in male and 89 mmHg in female. Conclusions. MAP is an independent predictor for incident NAFLD among nonobese female with normal LDL levels.

Evaluating the relative importance of different blood pressure indices in screening for NAFLD: a survey report based on a health examination population

“…The association between blood pressure indices and NAFLD has been reported in many studies, with published evidence generally supporting a positive correlation between SBP, DBP, PP, MAP, and NAFLD ( 14 – 16 , 31 – 34 ). However, it's noteworthy that most of these studies focused on evaluating the association of individual blood pressure indices with NAFLD and rarely assessed the impact of different indices on NAFLD risk simultaneously.…”

“…Reports on blood pressure indices in identifying NAFLD are currently quite limited. Most published studies have primarily focused on revealing the association between blood pressure indices and NAFLD ( 14 – 16 , 31 – 34 ), affirming the importance of blood pressure indices in NAFLD risk assessment, even at normal blood pressure levels. After establishing this association, further evaluating the value of blood pressure indices in identifying NAFLD is worth researching and emphasizing.…”

“…After establishing this association, further evaluating the value of blood pressure indices in identifying NAFLD is worth researching and emphasizing. In a recent study by Xu et al, they assessed the value of SBP, DBP, and MAP in identifying NAFLD in a non-obese population, noting that MAP had the highest value in identifying NAFLD compared to SBP and DBP ( 34 ). Similarly to Xu et al's findings, our study, including both obese and non-obese individuals in a general health examination population, found MAP to have the highest value in identifying NAFLD (AUC: 0.7258).…”

Association Between Hypertension and New-Onset Non-Alcoholic Fatty Liver Disease in Chinese Non-Obese People: A Longitudinal Cohort Study

“…In contrast, MAP was not associated with incident NAFLD in males (P >0.05). 20 In another longitudinal study in China with 10,915 individuals, the researchers demonstrated that elevated SBP levels within the normal range were connected to significantly higher risks of NAFLD. 23 In a cross-sectional study in Greece, Michopoulos et al found that newly diagnosed essential hypertension was independently associated with NAFLD (OR=2.18,95% CI:1.25,3.78).…”

“…Multifactorial hypertension is a growing public health problem caused by the interaction between genetic predisposition and environmental factors, affecting ≈30% of the general population. 18 NAFLD is significantly associated with blood pressure (BP), [19][20][21][22] even in individuals without hypertension. 22,23 Aneni et al showed that early hypertension might lead to NAFLD even in the absence of other metabolic risk factors and indicated that controlling blood pressure might help prevent or limit NAFLD in non-obese patients with hypertension.…”