Moon Hee Yang1, Jidong Sung2, Geum-Youn Gwak3. 1. Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 2. Division of Cardiology, Department of Medicine, Heart Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: jidong.sung@samsung.com. 3. Division of Gastroenterology and Hepatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Abstract
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is associated with a higher risk of cardiovascular disease, but the relationship has not been established in nonobese populations. Higher apolipoprotein B (apo B) levels and the apo B/A1 ratio and lower apo A1 levels are associated with an elevated risk of cardiovascular disease. We investigated the associations between apo B, apo A1, and the apo B/A1 ratio and the presence of metabolic syndrome and NAFLD in both normal-weight and overweight Koreans. METHODS: This cross-sectional study consisted of 8327 consecutive both normal-weight and overweight Koreans with NAFLD diagnosed by ultrasonography at the Samsung Medical Center in Korea from January 2008 to December 2010. RESULTS: The prevalence of NAFLD was 27.1% among the 8327 participants. Higher serum triglyceride levels and the apo B/A1 ratio and lower high-density lipoprotein cholesterol and apo A1 levels were significantly associated with higher prevalence of metabolic syndrome in both normal-weight group and overweight group. The multivariate-adjusted odds ratios (ORs) for NAFLD in normal-weight group after comparing the fourth vs the first quartiles of the triglyceride, HDL cholesterol, low-density lipoprotein (LDL) cholesterol, apo B, apo A1, and the apo B/A1 ratio data were 2.89 (95% confidence interval [CI], 2.19-3.83; P trend < .001), 0.60 (95% CI, 0.46-0.78; P trend < .001), 1.67 (95% CI, 1.33-2.11; P trend < .001), 1.88 (95% CI, 1.48-2.39; P trend < .001), 0.73 (95% CI, 0.58-0.93; P trend < .001), and 1.86 (95% CI, 1.45-2.38; P trend < .001), respectively. The corresponding adjusted ORs in the overweight group were 3.43 (95% CI, 2.60-4.54; P trend < .001), 0.89 (95% CI, 0.68-1.16; P trend = .221), 1.41 (95% CI, 1.11-1.78; P trend = .001), 1.58 (95% CI, 1.21-2.06; P trend < .001), 0.99 (95% CI, 0.77-1.27; P trend = .958), and 1.53 (1.16-2.01; P trend = .002), respectively. CONCLUSIONS: Higher serum triglyceride, LDL cholesterol, apo B1 levels, and the apo B/A1 ratio were significantly associated with NAFLD independent of metabolic syndrome in both normal-weight and overweight Koreans. Lower serum HDL cholesterol and apo A1 levels were related to NAFLD in normal-weight participants. Our results suggest that the presence of NAFLD may be associated with increased risk for coronary artery disease in both normal-weight and overweight Koreans.
BACKGROUND:Nonalcoholic fatty liver disease (NAFLD) is associated with a higher risk of cardiovascular disease, but the relationship has not been established in nonobese populations. Higher apolipoprotein B (apo B) levels and the apo B/A1 ratio and lower apo A1 levels are associated with an elevated risk of cardiovascular disease. We investigated the associations between apo B, apo A1, and the apo B/A1 ratio and the presence of metabolic syndrome and NAFLD in both normal-weight and overweight Koreans. METHODS: This cross-sectional study consisted of 8327 consecutive both normal-weight and overweight Koreans with NAFLD diagnosed by ultrasonography at the Samsung Medical Center in Korea from January 2008 to December 2010. RESULTS: The prevalence of NAFLD was 27.1% among the 8327 participants. Higher serum triglyceride levels and the apo B/A1 ratio and lower high-density lipoprotein cholesterol and apo A1 levels were significantly associated with higher prevalence of metabolic syndrome in both normal-weight group and overweight group. The multivariate-adjusted odds ratios (ORs) for NAFLD in normal-weight group after comparing the fourth vs the first quartiles of the triglyceride, HDL cholesterol, low-density lipoprotein (LDL) cholesterol, apo B, apo A1, and the apo B/A1 ratio data were 2.89 (95% confidence interval [CI], 2.19-3.83; P trend < .001), 0.60 (95% CI, 0.46-0.78; P trend < .001), 1.67 (95% CI, 1.33-2.11; P trend < .001), 1.88 (95% CI, 1.48-2.39; P trend < .001), 0.73 (95% CI, 0.58-0.93; P trend < .001), and 1.86 (95% CI, 1.45-2.38; P trend < .001), respectively. The corresponding adjusted ORs in the overweight group were 3.43 (95% CI, 2.60-4.54; P trend < .001), 0.89 (95% CI, 0.68-1.16; P trend = .221), 1.41 (95% CI, 1.11-1.78; P trend = .001), 1.58 (95% CI, 1.21-2.06; P trend < .001), 0.99 (95% CI, 0.77-1.27; P trend = .958), and 1.53 (1.16-2.01; P trend = .002), respectively. CONCLUSIONS: Higher serum triglyceride, LDL cholesterol, apo B1 levels, and the apo B/A1 ratio were significantly associated with NAFLD independent of metabolic syndrome in both normal-weight and overweight Koreans. Lower serum HDL cholesterol and apo A1 levels were related to NAFLD in normal-weight participants. Our results suggest that the presence of NAFLD may be associated with increased risk for coronary artery disease in both normal-weight and overweight Koreans.