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Nonalcoholic Fatty Liver Disease for Identification of Preclinical Carotid Atherosclerosis

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ABSTRACT

Nonalcoholic fatty liver disease (NAFLD) is associated with cardiovascular disease, yet whether identification of NAFLD in asymptomatic individuals is helpful over established risk factors remains unknown. A total of 37,799 asymptomatic adults aged 20 years or older who underwent comprehensive health check-up examination, including abdominal and carotid artery duplex ultrasonography (US) were included in the analysis. Nonalcoholic fatty liver disease was diagnosed with US and exclusion of secondary causes of fat accumulation or other causes of chronic liver disease, and graded as mild or moderate to severe fatty liver. Individuals with carotid plaque identified on carotid artery US were considered at risk for cardiovascular disease. Metabolic syndrome (MetS) was defined by the adult treatment panel III criteria. Nonalcoholic fatty liver disease was an independent factor associated with carotid plaque in a dose-dependent manner (odds ratio [OR]; 95% confidence interval [CI]: 1.09 [1.03–1.16] and 1.13 [1.06–1.21] for mild and ≥ moderate degree of NAFLD). Among clinically-relevant subgroups, NAFLD was more closely associated with carotid plaque in young adults (aged < 60 years) without MetS (OR [95% CI]: 1.13 [1.03–1.19] and 1.16 [1.06–1.27] for mild and ≥ moderate degree of NAFLD) than old adults (aged ≥ 60 years) or with MetS (OR [95% CI]: 1.06 [0.97–1.17] and 1.07 [0.97–1.19] for mild and ≥ moderate degree NAFLD). In young adults without MetS, the prevalence of carotid plaques was 32.8% and the sensitivity and specificity of NAFLD for carotid plaque was 0.38 and 0.67, respectively. In conclusion, NAFLD is associated with carotid plaque independent of traditional risk factors, especially in young adults without MetS. Nonalcoholic fatty liver disease could help identify additional individuals with preclinical atherosclerosis in asymptomatic young adults without MetS, yet, showed suboptimal performance as a screening tool.

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Association between carotid plaque and non-alcoholic fatty liver disease by clinically relevant subgroup. The association between carotid plaque and nonalcoholic fatty liver disease was more evident for those with young adults and those without metabolic syndrome.
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Figure 3: Association between carotid plaque and non-alcoholic fatty liver disease by clinically relevant subgroup. The association between carotid plaque and nonalcoholic fatty liver disease was more evident for those with young adults and those without metabolic syndrome.

Mentions: Age was strongly associated with carotid plaque. Nonalcoholic fatty liver disease was also associated with age, and was more frequently observed in individuals aged <60 years than ≥60 years (42.7% vs. 35.6%, P < 0.001). Among participants with carotid plaque, mean age of those with NAFLD were younger than those without NAFLD (54.0 ± 8.6 vs. 56.0 ± 9.0, P < 0.001). The association between NAFLD and carotid plaque was more prominent in young adults (aged <60 years; OR [95% CI]: 1.10 [1.03–1.18] and 1.14 [1.06–1.23] for mild and ≥ moderate degree of NAFLD), than in older adults (aged ≥ 60 years; OR [95% CI]: 1.09 [0.95–1.24] and 1.02 [0.87–1.19] for mild and ≥ moderate degree of NAFLD) (Figure 3). Nonalcoholic fatty liver disease was closely associated with MetS. The prevalence of NAFLD was high (70.3%) in individuals with MetS whereas it was low (16.3%) in individuals without any MetS component; the rate was in between (41.4%) for those with 1 or 2 MetS component (P < 0.001). The association between NAFLD and carotid plaque was more prominent in individuals without any MetS components (OR [95% CI]: 1.15 [1.01–1.32] and 1.26 [1.02–1.58] for mild and ≥ moderate degree of NAFLD) than in individuals with one or two MetS components (OR [95% CI]: 1.08 [1.01–1.17] and 1.14 [1.04–1.24] for mild and ≥ moderate degree NAFLD), or in individuals with MetS (OR [95% CI]: 1.06 [0.95–1.20] and 1.08 [0.96–1.22] for mild and ≥ moderate degree of NAFLD). When further stratified by age and MetS status, significant association between NAFLD and carotid plaque was observed for young adults without MetS (OR [95% CI]: 1.13 [1.03–1.19] and 1.16 [1.06–1.27] for mild and ≥ moderate degree of NAFLD), whereas the association was not statistically significant for old adults or those with MetS (OR [95% CI]: 1.06 [0.97–1.17] and 1.07 [0.97–1.19] for mild and ≥ moderate degree NAFLD).


Nonalcoholic Fatty Liver Disease for Identification of Preclinical Carotid Atherosclerosis
Association between carotid plaque and non-alcoholic fatty liver disease by clinically relevant subgroup. The association between carotid plaque and nonalcoholic fatty liver disease was more evident for those with young adults and those without metabolic syndrome.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998289&req=5

Figure 3: Association between carotid plaque and non-alcoholic fatty liver disease by clinically relevant subgroup. The association between carotid plaque and nonalcoholic fatty liver disease was more evident for those with young adults and those without metabolic syndrome.
Mentions: Age was strongly associated with carotid plaque. Nonalcoholic fatty liver disease was also associated with age, and was more frequently observed in individuals aged <60 years than ≥60 years (42.7% vs. 35.6%, P < 0.001). Among participants with carotid plaque, mean age of those with NAFLD were younger than those without NAFLD (54.0 ± 8.6 vs. 56.0 ± 9.0, P < 0.001). The association between NAFLD and carotid plaque was more prominent in young adults (aged <60 years; OR [95% CI]: 1.10 [1.03–1.18] and 1.14 [1.06–1.23] for mild and ≥ moderate degree of NAFLD), than in older adults (aged ≥ 60 years; OR [95% CI]: 1.09 [0.95–1.24] and 1.02 [0.87–1.19] for mild and ≥ moderate degree of NAFLD) (Figure 3). Nonalcoholic fatty liver disease was closely associated with MetS. The prevalence of NAFLD was high (70.3%) in individuals with MetS whereas it was low (16.3%) in individuals without any MetS component; the rate was in between (41.4%) for those with 1 or 2 MetS component (P < 0.001). The association between NAFLD and carotid plaque was more prominent in individuals without any MetS components (OR [95% CI]: 1.15 [1.01–1.32] and 1.26 [1.02–1.58] for mild and ≥ moderate degree of NAFLD) than in individuals with one or two MetS components (OR [95% CI]: 1.08 [1.01–1.17] and 1.14 [1.04–1.24] for mild and ≥ moderate degree NAFLD), or in individuals with MetS (OR [95% CI]: 1.06 [0.95–1.20] and 1.08 [0.96–1.22] for mild and ≥ moderate degree of NAFLD). When further stratified by age and MetS status, significant association between NAFLD and carotid plaque was observed for young adults without MetS (OR [95% CI]: 1.13 [1.03–1.19] and 1.16 [1.06–1.27] for mild and ≥ moderate degree of NAFLD), whereas the association was not statistically significant for old adults or those with MetS (OR [95% CI]: 1.06 [0.97–1.17] and 1.07 [0.97–1.19] for mild and ≥ moderate degree NAFLD).

View Article: PubMed Central - PubMed

ABSTRACT

Nonalcoholic fatty liver disease (NAFLD) is associated with cardiovascular disease, yet whether identification of NAFLD in asymptomatic individuals is helpful over established risk factors remains unknown. A total of 37,799 asymptomatic adults aged 20 years or older who underwent comprehensive health check-up examination, including abdominal and carotid artery duplex ultrasonography (US) were included in the analysis. Nonalcoholic fatty liver disease was diagnosed with US and exclusion of secondary causes of fat accumulation or other causes of chronic liver disease, and graded as mild or moderate to severe fatty liver. Individuals with carotid plaque identified on carotid artery US were considered at risk for cardiovascular disease. Metabolic syndrome (MetS) was defined by the adult treatment panel III criteria. Nonalcoholic fatty liver disease was an independent factor associated with carotid plaque in a dose-dependent manner (odds ratio [OR]; 95% confidence interval [CI]: 1.09 [1.03&ndash;1.16] and 1.13 [1.06&ndash;1.21] for mild and &ge; moderate degree of NAFLD). Among clinically-relevant subgroups, NAFLD was more closely associated with carotid plaque in young adults (aged &lt; 60 years) without MetS (OR [95% CI]: 1.13 [1.03&ndash;1.19] and 1.16 [1.06&ndash;1.27] for mild and &ge; moderate degree of NAFLD) than old adults (aged &ge; 60 years) or with MetS (OR [95% CI]: 1.06 [0.97&ndash;1.17] and 1.07 [0.97&ndash;1.19] for mild and &ge; moderate degree NAFLD). In young adults without MetS, the prevalence of carotid plaques was 32.8% and the sensitivity and specificity of NAFLD for carotid plaque was 0.38 and 0.67, respectively. In conclusion, NAFLD is associated with carotid plaque independent of traditional risk factors, especially in young adults without MetS. Nonalcoholic fatty liver disease could help identify additional individuals with preclinical atherosclerosis in asymptomatic young adults without MetS, yet, showed suboptimal performance as a screening tool.

No MeSH data available.


Related in: MedlinePlus