Oumarou Nabi1, Jerome Boursier2,3, Karine Lacombe1,4, Philippe Mathurin5, Victor de Ledinghen6,7, Marcel Goldberg8,9, Marie Zins8,9, Lawrence Serfaty10,11. 1. Inserm UMR-S1136, IPLESP, Sorbonne Université, Paris, France. 2. HepatoGastroenterology Department, Anger University Hospital, Angers, France. 3. HIFIH Laboratory, UPRES EA3859, SFR 4208, Angers University, Angers, France. 4. Infectious Diseases Department, Hôpital Saint-Antoine, APHP, Paris, France. 5. Liver Unit, CHRU Lille, Lille, France. 6. Hepatology Unit, Bordeaux University Hospital, Bordeaux, France. 7. INSERM U1053, Bordeaux University, Bordeaux, France. 8. UMS 11 Inserm, Versailles-Saint Quentin University, Versailles, France. 9. Paris University, Paris, France. 10. Hepatogastroenterology Service, Hôpital Hautepierre, Hôpitaux Universitaires de Strasbourg, 67000, Strasbourg, France. lawrence.serfaty@chru-strasbourg.fr. 11. INSERM UMR_S938, Sorbonne Université, Paris, France. lawrence.serfaty@chru-strasbourg.fr.
Abstract
BACKGROUND: The relationship between the severity of NAFLD and extra-hepatic events such as cardiovascular disease (CVD), extra-hepatic cancer (EHC) or chronic kidney diseases (CKD) has not been clearly investigated in the general population. AIMS: The aim of this study was to assess whether the severity of fibrosis in NAFLD subjects was associated with extra-hepatic diseases based on noninvasive markers in a large population-based cohort. METHODS: The study population included a cohort of 118,664 participants from the nationwide CONSTANCES cohort. After excluding individuals with excessive alcohol consumption and other causes of liver disease, 102,344 were included. The noninvasive diagnosis of NAFLD and fibrosis was performed using a combination of the Fatty Liver Index (FLI) and the Forns Index. The history of CVD or EHC was recorded by a physician, and CKD was defined by a glomerular filtration rate < 60 ml/mn. RESULTS: The prevalence of NAFLD (FLI > 60) was 18.2%, 10% with mild fibrosis (Forns Index < 4.2), 7.7% with intermediate fibrosis (Forns Index 4.2-6.9), and 0.4% with advanced fibrosis (Forns Index > 6.9). The prevalence of CVD, EHC, or CKD increased significantly with the severity of fibrosis (p < 0.0001). When adjusted for demographic, metabolic risk factors, and smoking, NAFLD with intermediate or advanced fibrosis remained associated with CVD (OR 1.36, p < 0.0001 and OR 3.07, p < 0.0001, respectively), EHC (OR 1.24, p = 0.001 and OR 1.64, p = 0.004, respectively), and CKD (OR 1.18, p = 0.03 and OR 2.09, p < 0.0001, respectively). CONCLUSIONS: In a large adult population-based cohort, there is a dose-dependent relationship between the severity of fibrosis and CVD, EHC, or CKD in NAFLD subjects.
BACKGROUND: The relationship between the severity of NAFLD and extra-hepatic events such as cardiovascular disease (CVD), extra-hepatic cancer (EHC) or chronic kidney diseases (CKD) has not been clearly investigated in the general population. AIMS: The aim of this study was to assess whether the severity of fibrosis in NAFLD subjects was associated with extra-hepatic diseases based on noninvasive markers in a large population-based cohort. METHODS: The study population included a cohort of 118,664 participants from the nationwide CONSTANCES cohort. After excluding individuals with excessive alcohol consumption and other causes of liver disease, 102,344 were included. The noninvasive diagnosis of NAFLD and fibrosis was performed using a combination of the Fatty Liver Index (FLI) and the Forns Index. The history of CVD or EHC was recorded by a physician, and CKD was defined by a glomerular filtration rate < 60 ml/mn. RESULTS: The prevalence of NAFLD (FLI > 60) was 18.2%, 10% with mild fibrosis (Forns Index < 4.2), 7.7% with intermediate fibrosis (Forns Index 4.2-6.9), and 0.4% with advanced fibrosis (Forns Index > 6.9). The prevalence of CVD, EHC, or CKD increased significantly with the severity of fibrosis (p < 0.0001). When adjusted for demographic, metabolic risk factors, and smoking, NAFLD with intermediate or advanced fibrosis remained associated with CVD (OR 1.36, p < 0.0001 and OR 3.07, p < 0.0001, respectively), EHC (OR 1.24, p = 0.001 and OR 1.64, p = 0.004, respectively), and CKD (OR 1.18, p = 0.03 and OR 2.09, p < 0.0001, respectively). CONCLUSIONS: In a large adult population-based cohort, there is a dose-dependent relationship between the severity of fibrosis and CVD, EHC, or CKD in NAFLD subjects.
Authors: Xavier Forns; Sergi Ampurdanès; Josep M Llovet; John Aponte; Llorenç Quintó; Eva Martínez-Bauer; Miquel Bruguera; Jose Maria Sánchez-Tapias; Juan Rodés Journal: Hepatology Date: 2002-10 Impact factor: 17.425
Authors: Yvonne Huber; Christian Labenz; Maurice Michel; Marcus-A Wörns; Peter R Galle; Karel Kostev; Jörn M Schattenberg Journal: Dtsch Arztebl Int Date: 2020-10-23 Impact factor: 5.594
Authors: Alessandro Mantovani; Graziana Petracca; Giorgia Beatrice; Alessandro Csermely; Amedeo Lonardo; Jörn M Schattenberg; Herbert Tilg; Christopher D Byrne; Giovanni Targher Journal: Gut Date: 2020-12-10 Impact factor: 23.059