The Association Between Nonalcoholic Fatty Liver Disease and Metabolic Abnormalities in The United States Population

Abstract

Background Prevalence of nonalcoholic fatty liver disease (NAFLD) and rate of advanced fibrosis among individuals with metabolic syndrome (MetS) and its individual metabolic abnormalities needs better understanding in the United States population. We aim to study these by using a large United States population database, the Third National Health and Nutrition Examination Survey (NHANES III). Methods A total of 11,674 individuals were included in our study cohort. NAFLD was defined as presence of moderate to severe hepatic steatosis on liver ultrasound in absence of viral hepatitis, significant alcohol use, elevated transferrin level and medication use leading to hepatic steatosis. Advanced fibrosis among those with NAFLD was determined using noninvasive method, the NAFLD Fibrosis Score. MetS was defined based on the National Cholesterol Education Program Adult Treatment Panel III definition. Results The prevalence of NAFLD among included study cohort was 18.2% (95% CI 16.5–19.9). Individuals with metabolic abnormalities demonstrated higher prevalence (MetS: 43.2%, increased waist circumference: 31.2%, impaired fasting glucose/diabetes: 41.2%, high triglyceride level: 34.7%, low HDL: 27.8%, high blood pressure: 29.2%). The individuals with MetS had significantly higher NAFLD prevalence compared to controls (aOR: 11.5, 95% CI 8.9–14.7). The severity of hepatic steatosis was also noted to increase with higher number of metabolic abnormalities. Among individual metabolic abnormalities, increased waist circumference, impaired fasting glucose/diabetes, high triglyceride and low HDL levels were found to be independently associated with NAFLD. Individuals with impaired fasting glucose/diabetes and those with five metabolic abnormalities had higher rate of advanced fibrosis (18.6% and 30.3% respectively). Prevalence of NAFLD among individuals without any metabolic abnormality was 6.1%. Conclusion Prevalence of NAFLD and rate of advanced fibrosis are significantly high among individuals with metabolic abnormalities.

Nuclear envelope–localized torsinA-LAP1 complex regulates hepatic VLDL secretion and steatosis

“…These comorbidities are often merged under the umbrella of metabolic syndrome (32). There is broad consensus that these features of metabolic syndrome are strongly associated with NAFLD in the majority of affected individuals (33). In contrast, recent work has identified several genetic insults that predispose individuals to NAFLD, NASH, and even cirrhosis in a liver-autonomous manner, unaccompanied by the features of metabolic syndrome (34,35).…”

NAFLD as a continuum: from obesity to metabolic syndrome and diabetes

“…The association of MetS with the prevalence and severity of NAFLD, assessed by US and NAFLD Fibrosis score (NFS), was evaluated in a cohort of 11,647 individuals [21]. Despite the prevalence of NAFLD was 18.2% (95% CI 16.5-19.9), it was significantly greater (43.2%) in those with MetS (OR 11.5, 95%CI 8.9-14.7) and increased with the number of MetS criteria (67% for those with all five criteria).…”

Macrophages in obesity and non-alcoholic fatty liver disease: Crosstalk with metabolism

“…7 In particular, depending on selection criteria, the prevalence of NAFLD in type 2 diabetic patients ranges from 30 to almost 100%. [8][9][10][11] Nevertheless, NAFLD is not only a manifestation of, but can also precede the development of other components of the metabolic syndrome, which has sparked a debate over the direction of the causal relations involved. 12 Indeed, insulin resistance and ectopic fat accumulation interconnect NAFLD with other metabolic disorders such as obesity, type 2 diabetes mellitus and atherosclerosis.…”